Section 210-RICR-10-00-1.7 - Direct Reimbursement to BeneficiariesA. Some individuals, while appealing a determination of Medicaid ineligibility, incur and pay for covered services. Direct reimbursement may be available to beneficiaries in certain circumstances. Direct reimbursement is available to such individuals if, and only if, all of the following requirements are met: 1. A written request to appeal a denial or discontinuance of Medicaid coverage is received by the State within the time frame specified in the) "Appeals Process and Procedures for EOHHS Agencies and Programs" (Subchapter 05 Part 2 of this Chapter) regulations.2. The original decision to deny or discontinue Medicaid coverage is reversed on appeal by the Appeals Officer or by the Regional Manager or Chief Supervisor/Supervisor).3. Reimbursement is only available if the original decision was reversed. Reimbursement is not made, for example, if the original decision is reversed because information or documentation, not provided during the application period, is provided at the time of the appeal.
4. The beneficiary submits the following:a. A completed Application for Reimbursement form;b. A copy of the medical provider's bill or a written statement from the provider which includes the date and type of service;c. Proof of the date and amount of payment made to the provider by the beneficiary or a person legally responsible for the beneficiary. A cash receipt, a copy of a canceled check or bank debit statement, a copy of a paid medical bill, or a written statement from the medical provider may be used as proof of payment, provided the document includes the date and amount of the payment and indicates that payment was made to the medical provider by the beneficiary or a person legally responsible for the beneficiary.5. Payment for the medical service was made during the period between a denial of Medicaid eligibility and a successful appeal of that denial. That is, payment was made on or after the date of the written notice of denial (or the effective date of Medicaid termination, if later) and before the date of the written decision issued by the EOHHS Appeals Office, or decision by the Regional Manager/Chief Casework Supervisor after, reversing such denial is implemented (or the date Medicaid eligibility is approved, if earlier).210 R.I. Code R. 210-RICR-10-00-1.7
Amended effective 3/17/2024