Section 210-RICR-20-00-1.4 - Medicaid Payment PolicyA. Medicaid is the payor of last resort. Community, public, and private resources such as Federal Medicare, Veteran's Administration benefits, accident settlements, or other health insurance plans must be utilized fully before payment from the Medicaid program can be authorized, including for prenatal services, labor, delivery, and postpartum care services. However, the State makes payments without regard to third (3rd) party liability for pediatric preventive services, unless the State has made a determination related to cost-effectiveness and access to care that warrants cost avoidance for ninety (90) days. The State may also make payments without regard to potential third (3rd) party liability for up to one hundred (100) days for claims related to child support enforcement beneficiaries.B. Payments to physicians and other providers of medical services and supplies are made in accordance with contractual arrangements with health plans or on a fee-for-service basis in accordance with applicable Federal and State Rules and Regulations, the Medicaid State Plan, and the State's Section 1115 demonstration waiver.C. Payments to Medicaid providers represent full and total payment. No supplementary payments are allowed, except as specifically provided in the contract. Direct reimbursement to recipients is prohibited except in specific circumstances to correct a denial that is reversed on appeal.210 R.I. Code R. 210-RICR-20-00-1.4
Amended effective 3/17/2022
Amended effective 7/17/2023
Amended effective 3/17/2024