28-6-1. Provision of medical services and remedial care authorized--Rules.

The Department of Social Services may provide medical services and medical or remedial care on behalf of persons having insufficient income and resources to meet the necessary cost thereof, if the person has exhausted all other possible public and private medical and remedial care programs, income, or benefits, with the exception of county poor relief, in accordance with rules which the secretary of social services shall promulgate pursuant to chapter 1-26. The rules shall specify the individuals and services for which state funds or federal financial participation are available and may include:

(1)    The amount, scope, and duration of medical and remedial services;

(2)    The basis for and extent of provider payments on behalf of an eligible person;

(3)    The establishment and collection of copayments, premiums, fees, or charges for sharing the cost of risk protection or services provided to persons. All such collections shall be remitted to the general fund;

(4)    Methods of administration found necessary for the operation of the medical assistance program;

(5)    Safeguards against the disclosure or improper use of information, required by statutory law to be held confidential, concerning applicants for or recipients of medical assistance; and

(6)    Such other requirements as may be necessary to obtain federal financial participation in the medical assistance program.

Source: SL 1966, ch 191, § 1; SL 1981, ch 199, § 31; SL 1982, ch 203, § 1; SL 1987, ch 29, § 10; SL 2000, ch 132, § 10; SL 2004, ch 167, § 51; SL 2019, ch 127, § 9.

28-6-1.1. Establishment of fee schedules--Posting of fees, changes--Applicability of chapter 1-26.

The Department of Social Services may establish or amend fee schedules used to pay for items and services covered by the medical assistance program under the provisions of this chapter without following the procedures set forth in §§ 1-26-4 to 1-26-6, inclusive. The department shall post the fee schedules on the department's website and shall notify website users of pending changes by posting a notice of the pending changes on the website at least forty-eight hours before the changes are made. Fee schedules posted on the department's website must be in accordance with the department's administrative rules promulgated under the provisions of chapter 1-26 which establish the reimbursement provisions for medical services.

Source: SL 2003, ch 156, § 1.

28-6-1.2. Reimbursement schedule for certain services--Medicaid program.

The Department of Social Services shall establish, maintain, and publish a reimbursement schedule for chiropractic, dental, and optometric services delivered under the Medicaid program. The schedule shall provide a reimbursement amount for each service.

The department shall determine reimbursement amounts, for each service, based on a percentage of current normal and customary fees in this state.

The department may seek the assistance of third parties to determine current normal and customary fees.

The department shall promulgate rules, pursuant to chapter 1-26, to establish and annually adjust the reimbursement schedule.

Source: SL 2022, ch 87, § 1.