Section 210-RICR-20-00-3.3 - Requirement of Prior AuthorizationA. Payment for out-of-State medical services that are provided to eligible Medicaid beneficiaries living within Rhode Island requires prior authorization from the Executive Office of Health and Human Services (EOHHS).B. The following conditions must be met to obtain prior authorization for out-of-State medical services: 1. If a Medicaid beneficiary requires services from an out-of-State hospital or physician, the beneficiary's attending physician must submit written medical justification to EOHHS;2. The medical services that are required and being requested must not be available within Rhode Island.C. Out-of-State medical services require prior authorization. Only those services that are contained within the Rhode Island Medicaid scope of services will be reimbursed.210 R.I. Code R. 210-RICR-20-00-3.3
Amended effective 10/5/2021