§ 40-8-4.1 Lowest price. – (a) Notwithstanding any provision of law to the contrary, no medical assistanceprovider shall bill or charge the department of human services more than theprovider's usual and customary charge, as defined within.
(b) The term "usual and customary" means the lowest charge,fee, or rate charged by a provider for any product or service at the time suchproduct or service was provided. For the purpose of determining the lowestcharge, fee, or rate:
(1) If the provider offers discounts or rebates, the amountafter applying discounts or rebates shall be utilized;
(2) If the provider offers a sale for a limited period oftime on any good or service, the sale price shall be utilized during the saleperiod;
(3) If the provider regularly accepts less than its fullcharge from any customer, that amount accepted shall be utilized;
(4) If any good or service is offered free of charge by theprovider, no charge shall be made to the department for the provision of theproduct or service to the department or a client of the department whosatisfies the terms of the offer;
(5) If any good or service is covered under any warranty orguarantee offered by the provider, the amount charged to the department shallnot exceed the amount which would otherwise be payable solely by the customer;and
(6) If a provider structures or packages its goods orservices in a manner which is exclusively or primarily used for Medicaid,Medicare, or other third-party payors, the charge for the most similar good orservice offered to any other consumer shall be utilized.
(c) The following items shall not be utilized in determiningthe "usual and customary" or lowest charge, fee, or rate:
(1) Discounts offered solely to bona fide employees or familymembers of employees;
(2) Discounts offered solely on the basis of age shall beutilized in determining the usual and customary charge only when the client ofthe department satisfies the age requirement;
(3) Free goods or services or discounts provided to a limitednumber of persons on the basis of financial hardship;
(4) Charges by an organization on a sliding fee scale for agood or service where the organization's charge is based on ability to pay;
(5) Charges not collected as a result of bad debts incurredby the provider. A bad debt exists where sound business judgment indicates thatthere is no reasonable likelihood of recovery of the amount owed; and
(6) Charges for educational-related services governed by 42U.S.C. § 1396b(c).
(d) The department may waive the application of this section,if the department determines such action is necessary to ensure a continuum ofcare and service to persons served by community mental health centers, or toavert serious economic hardships to mental health centers.
§ 40-8-4.1 Lowest price. – (a) Notwithstanding any provision of law to the contrary, no medical assistanceprovider shall bill or charge the department of human services more than theprovider's usual and customary charge, as defined within.
(b) The term "usual and customary" means the lowest charge,fee, or rate charged by a provider for any product or service at the time suchproduct or service was provided. For the purpose of determining the lowestcharge, fee, or rate:
(1) If the provider offers discounts or rebates, the amountafter applying discounts or rebates shall be utilized;
(2) If the provider offers a sale for a limited period oftime on any good or service, the sale price shall be utilized during the saleperiod;
(3) If the provider regularly accepts less than its fullcharge from any customer, that amount accepted shall be utilized;
(4) If any good or service is offered free of charge by theprovider, no charge shall be made to the department for the provision of theproduct or service to the department or a client of the department whosatisfies the terms of the offer;
(5) If any good or service is covered under any warranty orguarantee offered by the provider, the amount charged to the department shallnot exceed the amount which would otherwise be payable solely by the customer;and
(6) If a provider structures or packages its goods orservices in a manner which is exclusively or primarily used for Medicaid,Medicare, or other third-party payors, the charge for the most similar good orservice offered to any other consumer shall be utilized.
(c) The following items shall not be utilized in determiningthe "usual and customary" or lowest charge, fee, or rate:
(1) Discounts offered solely to bona fide employees or familymembers of employees;
(2) Discounts offered solely on the basis of age shall beutilized in determining the usual and customary charge only when the client ofthe department satisfies the age requirement;
(3) Free goods or services or discounts provided to a limitednumber of persons on the basis of financial hardship;
(4) Charges by an organization on a sliding fee scale for agood or service where the organization's charge is based on ability to pay;
(5) Charges not collected as a result of bad debts incurredby the provider. A bad debt exists where sound business judgment indicates thatthere is no reasonable likelihood of recovery of the amount owed; and
(6) Charges for educational-related services governed by 42U.S.C. § 1396b(c).
(d) The department may waive the application of this section,if the department determines such action is necessary to ensure a continuum ofcare and service to persons served by community mental health centers, or toavert serious economic hardships to mental health centers.
§ 40-8-4.1 Lowest price. – (a) Notwithstanding any provision of law to the contrary, no medical assistanceprovider shall bill or charge the department of human services more than theprovider's usual and customary charge, as defined within.
(b) The term "usual and customary" means the lowest charge,fee, or rate charged by a provider for any product or service at the time suchproduct or service was provided. For the purpose of determining the lowestcharge, fee, or rate:
(1) If the provider offers discounts or rebates, the amountafter applying discounts or rebates shall be utilized;
(2) If the provider offers a sale for a limited period oftime on any good or service, the sale price shall be utilized during the saleperiod;
(3) If the provider regularly accepts less than its fullcharge from any customer, that amount accepted shall be utilized;
(4) If any good or service is offered free of charge by theprovider, no charge shall be made to the department for the provision of theproduct or service to the department or a client of the department whosatisfies the terms of the offer;
(5) If any good or service is covered under any warranty orguarantee offered by the provider, the amount charged to the department shallnot exceed the amount which would otherwise be payable solely by the customer;and
(6) If a provider structures or packages its goods orservices in a manner which is exclusively or primarily used for Medicaid,Medicare, or other third-party payors, the charge for the most similar good orservice offered to any other consumer shall be utilized.
(c) The following items shall not be utilized in determiningthe "usual and customary" or lowest charge, fee, or rate:
(1) Discounts offered solely to bona fide employees or familymembers of employees;
(2) Discounts offered solely on the basis of age shall beutilized in determining the usual and customary charge only when the client ofthe department satisfies the age requirement;
(3) Free goods or services or discounts provided to a limitednumber of persons on the basis of financial hardship;
(4) Charges by an organization on a sliding fee scale for agood or service where the organization's charge is based on ability to pay;
(5) Charges not collected as a result of bad debts incurredby the provider. A bad debt exists where sound business judgment indicates thatthere is no reasonable likelihood of recovery of the amount owed; and
(6) Charges for educational-related services governed by 42U.S.C. § 1396b(c).
(d) The department may waive the application of this section,if the department determines such action is necessary to ensure a continuum ofcare and service to persons served by community mental health centers, or toavert serious economic hardships to mental health centers.
