Effective July 1, 2021, and for each subsequent year, the executive office of health and human services is hereby authorized and directed to amend its regulations for reimbursement to hospitals for inpatient and outpatient services as follows:
(a) Each hospital in the state of Rhode Island, as defined in § 23-17-38.1, shall receive a quarterly outpatient adjustment payment each state fiscal year of an amount determined as follows:
(1) Determine the percent of the state's total Medicaid outpatient and emergency department services (exclusive of physician services) provided by each hospital during each hospital's prior fiscal year;
(2) Determine the sum of all Medicaid payments to hospitals made for outpatient and emergency department services (exclusive of physician services) provided during each hospital's prior fiscal year;
(3) Multiply the sum of all Medicaid payments as determined in subsection (a)(2) by a percentage defined as the total identified upper payment limit for all hospitals divided by the sum of all Medicaid payments as determined in subsection (a)(2); and then multiply that result by each hospital's percentage of the state's total Medicaid outpatient and emergency department services as determined in subsection (a)(1) to obtain the total outpatient adjustment for each hospital to be paid each year;
(4) Pay each hospital on or before July 20, October 20, January 20, and April 20 one quarter (1/4) of its total outpatient adjustment as determined in subsection (a)(3).
(b) [Deleted by P.L. 2019, ch. 88, art. 13, § 6.]
(c) Each hospital in the state of Rhode Island, as defined in § 23-17-38.1(d)(1), shall receive a quarterly inpatient adjustment payment each state fiscal year of an amount determined as follows:
(1) Determine the percent of the state's total Medicaid inpatient services (exclusive of physician services) provided by each hospital during each hospital's prior fiscal year;
(2) Determine the sum of all Medicaid payments to hospitals made for inpatient services (exclusive of physician services) provided during each hospital's prior fiscal year;
(3) Multiply the sum of all Medicaid payments as determined in subsection (c)(2) by a percentage defined as the total identified upper payment limit for all hospitals divided by the sum of all Medicaid payments as determined in subsection (c)(2); and then multiply that result by each hospital's percentage of the state's total Medicaid inpatient services as determined in subsection (c)(1) to obtain the total inpatient adjustment for each hospital to be paid each year;
(4) Pay each hospital on or before July 20, October 20, January 20, and April 20 one quarter (1/4) of its total inpatient adjustment as determined in subsection (c)(3).
(d) The amounts determined in subsections (a) and (c) are in addition to Medicaid inpatient and outpatient payments and emergency services payments (exclusive of physician services) paid to hospitals in accordance with current state regulation and the Rhode Island Plan for Medicaid Assistance pursuant to Title XIX of the Social Security Act and are not subject to recoupment or settlement.
History of Section.
P.L. 2012, ch. 241, art. 15, § 2; P.L. 2014, ch. 145, art. 17, § 2; P.L. 2019, ch. 88, art. 13, § 6; P.L. 2021, ch. 162, art. 12, § 3, effective July 1, 2021.