§ 40-8.4-19 - Managed health care delivery systems for families. - Rhode Island Statutes

SECTION 40-8.4-19

   § 40-8.4-19  Managed health care deliverysystems for families. – (a) Notwithstanding any other provision of state law, the delivery andfinancing of the health care services provided under this chapter shall beprovided through a system of managed care. "Managed care" is defined as systemsthat: integrate an efficient financing mechanism with quality service delivery;provide a "medical home" to assure appropriate care and deter unnecessaryservices; and place emphasis on preventive and primary care.

   (b) Enrollment in managed care health delivery systems ismandatory for individuals eligible for medical assistance under this chapter.This includes children in substitute care, children receiving MedicalAssistance through an adoption subsidy, and children eligible for medicalassistance based on their disability. Beneficiaries with third-party medicalcoverage or insurance may be exempt from mandatory managed care in accordancewith rules and regulations promulgated by the department of human services forsuch purposes.

   (c) Individuals who can afford to contribute shall sharein the cost. The department of human services is authorized and directed toapply for and obtain any necessary waivers and/or state plan amendments fromthe secretary of the U.S. department of health and human services, including,but not limited to, a waiver of the appropriate sections of Title XIX, 42U.S.C. § 1396 et seq., to require that beneficiaries eligible under thischapter or chapter 12.3 of title 42, with incomes equal to or greater than onehundred fifty percent (150%) of the federal poverty level, pay a share of thecosts of health coverage based on the ability to pay. The department of humanservices shall implement this cost-sharing obligation by regulation, and shallconsider co-payments, premium shares, or other reasonable means to do so inaccordance with approved provisions of appropriate waivers and/or state planamendments approved by the secretary of the United States department of healthand human services.