Title 49, Chapter 4, Section 142
( 49-4-142)
(a) The Department of Community Health established under Chapter 5A
of Title 31 is authorized to adopt and administer a state plan for
medical assistance in accordance with Title XIX of the federal
Social Security Act, as amended (Act of July 30, 1965, P.L. 89-97,
79 Stat. 343, as amended), provided such state plan is administered
within the appropriations made available to the department. The
department is authorized to establish the amount, duration, scope,
and terms and conditions of eligibility for and receipt of such
medical assistance as it may elect to authorize pursuant to this
article. Further, the department is authorized to establish such
rules and regulations as may be necessary or desirable in order to
execute the state plan and to receive the maximum amount of federal
financial participation available in expenditures made pursuant to
the state plan; provided, however, the department shall establish
reasonable procedures for notice to interested parties and an
opportunity to be heard prior to the adoption, amendment, or repeal
of any such rule or regulation. The department is authorized to
enter into such reciprocal and cooperative arrangements with other
states, persons, and institutions, public and private, as it may
deem necessary or desirable in order to execute the state plan. (b) The department shall, not later than June 1, 1986, implement a
modification of the state plan for medical assistance or any
affected rules or regulations of the department, which modification
will allow supplementation by relatives or other persons for a
private room or private sitter or both for a recipient of medical
assistance in a nursing home. The Department of Human Resources
shall likewise modify any affected rules and regulations of the
Department of Human Resources. The modification to the plan or to
any affected rules and regulations shall be effective unless and
until federal authorities rule that such modification is out of
compliance with federal regulations. Such modification of the state
plan for medical assistance or rules and regulations: (1) Shall provide that a provider of nursing home services in
either a skilled care facility or an intermediate care facility
shall be obligated to provide a recipient of medical assistance
only semiprivate accommodations which meet the other requirements
of appropriate regulations; (2) Shall provide that at no time can more than 10 percent of a
skilled care or intermediate care facility's rooms be used for
Medicaid recipients for whom a private room supplementation has
been made; (3) Shall provide that payments made by relatives or other persons
to a provider of medical assistance for the specific stated
purpose of paying the additional costs for a private room or
private sitter or both for a recipient of medical assistance in a
skilled care facility or intermediate care facility shall not be
considered as income when determining the amount of patient
liability toward vendor payments; provided, however, that the
department's entitlement to payments made by legally liable third
parties shall not be diminished by this modification of the state
plan; (4) Shall provide that no provider of medical assistance shall
discriminate against a recipient of medical assistance who does
not have a relative or other person who is willing and able to
provide supplementation; but the provision of a private room or
private sitter to a recipient when supplementation is provided
shall not constitute discrimination against other recipients; (5) Shall provide that no recipient who is transferred to or
admitted to a private room because of a shortage of beds in
semiprivate rooms shall be discharged because the recipient does
not have a relative or other person who is willing and able to
provide supplementation; and (6) May provide that the rate charged by the provider of medical
assistance to the relative or other person providing
supplementation for a private room for a recipient shall not
exceed the difference between the maximum rate charged by the
provider for a private room to or for a private pay patient and
the amount which the provider receives or will receive from the
department as reimbursement for otherwise providing for the
recipient's care in a semiprivate room. (c) The department is authorized to establish drug application fees
which shall be equal to the department's cost of investigating and
determining whether a new drug product should be included in the
Controlled Medical Assistance Drug List. Such fees shall be
adjusted annually and shall be paid by the drug manufacturers at the
time of application. |