Rhode Island § 40-8-2 - Medical Assistance

§ 40-8-2. Definitions.

As used in this chapter, unless the context shall otherwise require:

(1) “Dental service” means and includes emergency care, X-rays for diagnoses, extractions, palliative treatment, and the refitting and relining of existing dentures and prosthesis.

(2) “Department” means the department of human services.

(3) “Director” means the director of human services.

(4) “Drug” means and includes only drugs and biologicals prescribed by a licensed dentist or physician as are either included in the United States pharmacopoeia, national formulary, or are new and nonofficial drugs and remedies.

(5) “Inpatient” means a person admitted to and under treatment or care of a physician or surgeon in a hospital or nursing facility that meets standards of and complies with rules and regulations promulgated by the director.

(6) “Inpatient hospital services” means the following items and services furnished to an inpatient in a hospital other than a hospital, institution, or facility for tuberculosis or mental diseases:

(i) Bed and board;

(ii) Nursing services and other related services as are customarily furnished by the hospital for the care and treatment of inpatients and drugs, biologicals, supplies, appliances, and equipment for use in the hospital, as are customarily furnished by the hospital for the care and treatment of patients;

(iii)(A) Other diagnostic or therapeutic items or services, including, but not limited to, pathology, radiology, and anesthesiology furnished by the hospital or by others under arrangements made by the hospital, as are customarily furnished to inpatients either by the hospital or by others under such arrangements, and services as are customarily provided to inpatients in the hospital by an intern or resident-in-training under a teaching program having the approval of the Council on Medical Education and Hospitals of the American Medical Association or of any other recognized medical society approved by the director.

(B) The term “inpatient hospital services” shall be taken to include medical and surgical services provided by the inpatient’s physician, but shall not include the services of a private-duty nurse or services in a hospital, institution, or facility maintained primarily for the treatment and care of patients with tuberculosis or mental diseases. Provided, further, it shall be taken to include only the following organ transplant operations: kidney, liver, cornea, pancreas, bone marrow, lung, heart, and heart/lung, and other organ transplant operations as may be designated by the director after consultation with medical advisory staff or medical consultants; and provided that any such transplant operation is determined by the director or his or her designee to be medically necessary. Prior written approval of the director, or his or her designee, shall be required for all covered organ transplant operations.

(C) In determining medical necessity for organ transplant procedures, the state plan shall adopt a case-by-case approach and shall focus on the medical indications and contra-indications in each instance; the progressive nature of the disease; the existence of any alternative therapies; the life-threatening nature of the disease; the general state of health of the patient apart from the particular organ disease; and any other relevant facts and circumstances related to the applicant and the particular transplant procedure.

(7) “Nursing services” means the following items and services furnished to an inpatient in a nursing facility:

(i) Bed and board;

(ii) Nursing care and other related services as are customarily furnished to inpatients admitted to the nursing facility, and drugs, biologicals, supplies, appliances, and equipment for use in the facility, as are customarily furnished in the facility for the care and treatment of patients;

(iii) Other diagnostic or therapeutic items or services, legally furnished by the facility or by others under arrangements made by the facility, as are customarily furnished to inpatients either by the facility or by others under such arrangement;

(iv) Medical services provided in the facility by the inpatient’s physician, or by an intern or resident-in-training of a hospital with which the facility is affiliated or that is under the same control, under a teaching program of the hospital approved as provided in subsection (6); and

(v) A personal-needs allowance of seventy-five dollars ($75.00) per month.

(8) “Relative with whom the dependent child is living” means and includes the father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew, or niece of any dependent child who maintains a home for the dependent child.

(9) “Visiting nurse service” means part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse other than in a hospital or nursing home.