2023 -- S 0581

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- OFFICE OF HEALTH AND

HUMAN SERVICES

     

     Introduced By: Senators Ujifusa, Murray, Miller, Bell, Lauria, Zurier, Mack, Acosta,
DiMario, and Valverde

     Date Introduced: March 07, 2023

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 42-7.2-16 of the General Laws in Chapter 42-7.2 entitled "Office of

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Health and Human Services" is hereby amended to read as follows:

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     42-7.2-16. Medicaid System Reform 2008.

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     (a) The executive office of health and human services, in conjunction with the department

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of human services, the department of children, youth and families, the department of health and the

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department of behavioral healthcare, developmental disabilities and hospitals, is authorized to

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design options that further the reforms in Medicaid initiated in 2008 to ensure that the program:

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utilizes competitive and value based purchasing to maximize the available service options,

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promotes accountability and transparency, and encourages and rewards healthy outcomes,

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independence, and responsible choices; promotes efficiencies and the coordination of services

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across all health and human services agencies; and ensures the state will have a fiscally sound

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source of publicly-financed health care for Rhode Islanders in need.

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     (b) Principles and goals. In developing and implementing this system of reform, the

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executive office of health and human services and the four (4) health and human services

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departments shall pursue the following principles and goals:

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     (1) Empower consumers to make reasoned and cost-effective choices about their health by

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providing them with the information and array of service options they need and offering rewards

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for healthy decisions;

 

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     (2) Encourage personal responsibility by assuring the information available to beneficiaries

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is easy to understand and accurate, provide that a fiscal intermediary is provided when necessary,

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and adequate access to needed services;

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     (3) When appropriate, promote community-based care solutions by transitioning

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beneficiaries from institutional settings back into the community and by providing the needed

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assistance and supports to beneficiaries requiring long-term care or residential services who wish

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to remain, or are better served in the community;

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     (4) Enable consumers to receive individualized health care that is outcome-oriented,

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focused on prevention, disease management, recovery and maintaining independence;

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     (5) Promote competition between healthcare providers to ensure best value purchasing, to

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leverage resources and to create opportunities for improving service quality and performance;

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     (6) Redesign purchasing and payment methods to assure fiscal accountability and

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encourage and to reward service quality and cost-effectiveness by tying reimbursements to

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evidence-based performance measures and standards, including those related to patient satisfaction;

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and

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     (7) Continually improve technology to take advantage of recent innovations and advances

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that help decision makers, consumers and providers to make informed and cost-effective decisions

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regarding health care.

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     (c) The executive office of health and human services shall annually submit a report to the

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governor and the general assembly describing the status of the administration and implementation

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of the Medicaid Section 1115 demonstration waiver.

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     (d) The executive office of health and human services shall not enter into managed care

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organization (MCO) contracts that permit managed care organizations to contract with pharmacy

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benefit managers (PBM).

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- OFFICE OF HEALTH AND

HUMAN SERVICES

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     This act would prohibit the executive office of health and human services from entering

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into manage care organization (MCO) contracts that permit managed care organizations to contract

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with pharmacy benefit managers (PBM).

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     This act would take effect upon passage.

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