§ 42-12.3-5 - Managed care. - Rhode Island Statutes

SECTION 42-12.3-5

   § 42-12.3-5  Managed care. – The delivery and financing of the health care services provided pursuant to§§ 42-12.3-3 and 42-12.3-4 shall be provided through a system ofmanaged care.

   A managed care system integrates an efficient financingmechanism with quality service delivery, provides a "medical home" to assureappropriate care and deter unnecessary and inappropriate care, and placesemphasis on preventive and primary health care. In developing a managed caresystem the department of human services shall consider managed care modelsrecognized by the health care financing administration. The department of humanservices is hereby authorized and directed to seek any necessary approvals orwaivers from the U.S. Department of Health and Human Services, Health CareFinancing Administration, needed to assure that services are provided through amandatory managed care system. Certain health services may be provided on aninterim basis through a fee for service arrangement upon a finding that thereare temporary barriers to implementation of mandatory managed care for aparticular population or particular geographic area. Nothing in this sectionshall prohibit the department of human services from providing enhancedservices to medical assistance recipients within existing appropriations.