2014 -- S 3082

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LC005888

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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J O I N T   R E S O L U T I O N

CREATING A SPECIAL LEGISLATIVE COMMISSION TO STUDY THE IMPACT OF

HEALTH PLAN PATIENT LIABILITY PROVISIONS ON ACCESS TO HEALTHCARE AND

PROVIDER FINANCIAL CONDITION

     

     Introduced By: Senator Joshua Miller

     Date Introduced: June 05, 2014

     Referred To: Senate Health & Human Services

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     WHEREAS, It is the intention of state and federal law to ensure that Rhode Islanders

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have reasonable access to healthcare facilitated by health insurance coverage; and

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     WHEREAS, Individuals, employers, and employees select insurance coverage based on

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the balance between the level of coverage, reflected in the patient liability for services, and the

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cost of coverage, reflected in the premiums; and

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     WHEREAS, The reduced premiums associated with high deductible health plans and

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those that include other significant patient liability provisions have driven a sharp increase in the

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membership of these plans nationally and in Rhode Island; and

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     WHEREAS, The likelihood of collecting significant patient financial obligations, in the

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form of deductibles and other similar patient obligations, by healthcare providers diminishes

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sharply once the patient leaves the site of services; and

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     WHEREAS, The cost of healthcare provider time and resources required to bill and

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collect patient financial obligations significantly increases once the patient leaves the site of

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service; and

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     WHEREAS, Patient financial obligations can be of such a magnitude that it creates

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extreme personal financial hardship, hinders access to needed care, steers patients toward

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inappropriate places of service (such as hospital emergency departments) and in the event it is not

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paid, creates financial hardship on the part of the healthcare provider; and

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     WHEREAS, These provisions can cause unintended consequences that are in opposition

 

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to the objectives of access to coverage, availability of care, and the financial stability of

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healthcare providers; now, therefore be it

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     RESOLVED, That a special legislative commission be and the same hereby is created

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consisting of seventeen (17) members: one of whom shall be a member of the Senate, to be

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appointed by the Senate President, who shall serve as co-chairperson; one of whom shall be a

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member of the House, to be appointed by the Speaker of the House, who shall serve as co-

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chairperson; one of whom shall be the Commissioner of the Rhode Island Office of Health

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Insurance Commissioner, or designee; one of whom shall be the President/CEO of Blue Cross

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and Blue Shield of Rhode Island, or designee; one of whom shall be President of United

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Healthcare of Rhode Island, or designee; one of whom shall be the CEO of Neighborhood Health

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Plan of Rhode Island, or designee; one of whom shall be the Executive Director of the RI

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Business Group on Health, or designee; one of whom shall be a health insurance broker, to be

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appointed by the Health Insurance Commissioner; one of whom shall be the President of the Drug

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and Alcohol Treatment Association, or designee; one of whom shall be the President of the

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Community Health Center Association, or designee; one of whom shall be the President of the

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Council of Community Mental Health Organizations, or designee; two (2) of whom shall be the

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Executive Director of the Rhode Island Medical Society, or designee, plus an additional

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designated representative, to be appointed by the Executive Director of the Rhode Island Medical

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Society; two (2) of whom shall be the Acting President of the Hospital Association of Rhode

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Island, or designee, plus an additional designated representative, to be appointed by the Acting

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President of the Hospital Association of Rhode Island; one of whom shall be a representative of a

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hospital in Rhode Island that is not a member of the Hospital Association of Rhode Island, to be

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appointed by the Governor; and one of whom shall be a representative of state government with

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expertise in computer technology and information system compatibility, to be appointed by the

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Governor.

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     In lieu of any appointment of a member of the legislature to this commission, the

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appointing authority may appoint a member of the general public to serve in lieu of a legislator,

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provided that the public member is a resident of the State of Rhode Island.

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     The purpose of said commission shall be to make a comprehensive study and make

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recommendations regarding the impact of significant patient liability provisions within health

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plans (to include coinsurance and deductibles), and individuals' and employers' desire for choice

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in the cost of coverage resulting from different levels of patient liability and their relationship to a

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person's access to healthcare, health insurance, personal financial well-being and the financial

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condition of healthcare providers. In studying this issue, the commission is encouraged to:

 

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     (1) Examine trends, current policies, and available data pertaining to the growth in

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membership in health insurance plans containing significant patient liability provisions;

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     (2) Examine the impact upon the growth of coverage under the Affordable Care Act

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(ACA) of insurance plans with significant enrollee liability provisions and the coverage

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alternatives to such plans;

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     (3) Identify the volume of healthcare services rendered to patients with such coverage

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provisions and how much of the patient liability is collected and remains uncollected, and the

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time frames for billing and collection;

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     (4) Identify the barriers to access to necessary primary and specialty health care related to

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insurance coverage and potential financial barriers of patient liability provisions in coverage;

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     (5) Examine the degree to which health insurers, payers and employers evaluate the

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ability of potential members to afford the designated cost share prior to providing a plan that

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includes them, while similarly considering the impact of cost sharing on premiums, how that

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affordability of premiums improves access to health insurance and the degree to which coverage,

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even with cost sharing, is preferable to an individual or employee being uninsured;

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     (6) Survey the use of software applications that enable real-time determinations of a

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patient's deductible status and examine the feasibility of an application to be used by health care

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providers for utilization at the time care is provided; and

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     (7) Examine the implication and feasibility of policies and legislation that would (i)

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establish a baseline means test for affordability of significant patient financial obligations prior to

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their purchase, recognizing that coverage with that cost sharing is preferable to being uninsured,

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(ii) educate Rhode Islanders about the availability of Medicaid or other state assistance, premium

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subsidies (advance premium tax credits) and cost sharing subsidies under the ACA, and (iii)

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educate patients about their obligation to satisfy their financial liability to their healthcare

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provider.

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     Forthwith upon passage of the resolution, the members of the commission shall meet at

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the call of the Speaker of the House and the President of the Senate. The commission shall have

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the authority to organize and form subcommittees, when deemed appropriate by a majority of the

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members.

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     Vacancies in said commission shall be filled in the same manner as the original

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appointment.

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     The membership of said commission shall receive no compensation for their services.

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     All departments and agencies of the state shall furnish such advice and information,

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documentary and otherwise, to said commission and its agents as is deemed necessary or

 

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desirable by the commission to facilitate the purposes of this resolution.

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     The Joint Committee on Legislative Services is hereby authorized and directed to provide

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suitable quarters for said commission; and be it further

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     RESOLVED, That the Commission shall report its findings and recommendations,

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including any proposed legislation, to the Governor, the Commissioner of the Office of Health

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Insurance Commissioner, and the General Assembly no later than February 1, 2015, and said

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commission shall expire on July 1, 2015.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

J O I N T   R E S O L U T I O N

CREATING A SPECIAL LEGISLATIVE COMMISSION TO STUDY THE IMPACT OF

HEALTH PLAN PATIENT LIABILITY PROVISIONS ON ACCESS TO HEALTHCARE AND

PROVIDER FINANCIAL CONDITION

***

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     This resolution would create a seventeen (17) member special legislative study

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commission whose purpose it would be to study the impact of Health Plan Patient liability

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provisions on access to healthcare and provider financial condition, and who would report back to

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the General Assembly, the Governor, and the Commissioner of the Office of Health Insurance

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Commissioner, no later than February 1, 2015, and whose life would expire on July 1, 2015.

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