Chapter
113
2008 -- S 2484 SUBSTITUTE B AS AMENDED
Enacted 06/30/08
A N A C T
RELATING TO THE
HEALTH AND SAFETY - HEALTHY RHODE ISLAND REFORM ACT OF 2008
Introduced By: Senators Pichardo, Jabour, Gallo, Perry, and Paiva-Weed
Date Introduced: February 13, 2008
It is
enacted by the General Assembly as follows:
SECTION
1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is
hereby
amended
by adding thereto the following chapter:
CHAPTER 17.22
HEALTHY RHODE ISLAND REFORM ACT OF 2008
23-17.22-1.
Short title. – This chapter shall be known and may be cited as the
"Healthy
Rhode
Island Reform Act of 2008."
23-17.22-2.
Establishment of the healthy Rhode Island strategic plan. – (a) The
director
of health in consultation with the health care planning and accountability
advisory
council
established pursuant to chapter 81 of title 23, shall be responsible for the
development
and
implementation of a five (5) year strategic plan that charts the course for a
healthy Rhode
Island.
(b)
The director and the health care planning and accountability advisory council
shall
engage
a broad range of health care providers, health insurance plans, professional
organizations,
community
and nonprofit groups, consumers, businesses, school districts, and state and
local
government
in developing and implementing the healthy Rhode Island five (5) year strategic
plan.
(c)(1)
The healthy Rhode Island strategic plan shall include:
(i)
a description of the course charted to a healthy Rhode Island (the healthy
Rhode Island
model),
which includes patient self-management, emphasis on primary care, community
initiatives,
and health system and information technology reform, to be used uniformly
statewide
by
private insurers, third party administrators, and public programs;
(ii)
a description of prevention programs and how these programs are integrated into
communities,
with chronic care management, and the healthy Rhode Island model;
(iii)
a plan to develop and implement reimbursement systems aligned with the goal of
managing
the care for individuals with or at risk for conditions in order to improve
outcomes and
the
quality of care;
(iv)
the involvement of public and private groups, health care professionals,
insurers,
third
party administrators, associations, and firms to facilitate and assure the
sustainability of a
new
system of care;
(v)
the involvement of community and consumer groups to facilitate and assure the
sustainability
of health services supporting healthy behaviors and good patient
self-management
for
the prevention and management of chronic conditions;
(vi)
alignment of any information technology needs with other health care
information
technology
initiatives;
(vii)
the use and development of outcome measures and reporting requirements, aligned
with
outcome measures established by the director under this section, to assess and
evaluate the
healthy
Rhode Island model system of chronic care management;
(viii)
target timelines for inclusion of specific chronic conditions to be included in
the
chronic
care infrastructure and for statewide implementation of the healthy Rhode
Island model;
(ix)
identification of resource needs for implementation and sustaining the healthy
Rhode
Island
model and strategies to meet the identified needs; and
(x)
a strategy for ensuring statewide participation no later than January 1, 2010
by all
health
insurers, third-party administrators, health care professionals, health care
facilities as
defined
in section 23-17-2 of the Rhode Island general laws, and consumers in the
healthy Rhode
Island
chronic care management plan, including common outcome measures, best practices
and
protocols,
data reporting requirements, payment methodologies, and other standards.
(2)
The strategic plan shall be reviewed biennially and amended as necessary to
reflect
changes
in priorities. Amendments to the plan shall be reported to the general assembly
in the
report
established under subsection (d) of this section.
(d)(1)
The director shall report to the general assembly annually on the status of
implementation
of the Rhode Island blueprint for health. The report shall include the number
of
participating
insurers, health care facilities, health care professionals and patients; the
progress for
achieving
statewide participation in the chronic care management plan, including the
measures
established
under subsection (c) of this section; the expenditures and savings for the
period; the
results
of health care professional and patient satisfaction surveys; the progress
toward creation
and
implementation of privacy and security protocols; and other information as requested
by the
committees.
The surveys shall be developed in collaboration with the health care planning
and
accountability
advisory council.
(2)
If statewide participation in the healthy Rhode Island model for health is not
achieved
by
January 1, 2010, the director shall evaluate the healthy Rhode Island model for
health and
recommend
to the general assembly changes necessary to create alternative measures to
ensure
statewide
participation by all health insurers, third-party administrators, health care
facilities, and
health
care professionals.
23-17.22-3.
Healthy Rhode Island chronic care management program. – (a) The
director
shall create criteria for the healthy Rhode Island chronic care management
program as
provided
for in this section.
(b)
The director shall include a broad range of chronic conditions in the healthy
Rhode
Island
chronic care management program.
(c)
The healthy Rhode Island chronic care management program shall be designed to
include:
(1)
a method involving the health care professional in identifying eligible
patients,
including
the use of a chronic care information system established pursuant to this
section, an
enrollment
process which provides incentives and strategies for maximum patient
participation,
and a
standard statewide health risk assessment for each individual;
(2)
the process for coordinating care among health care professionals, including a
process
for
ensuring that each patient has a designated primary care physician;
(3)
the methods of increasing communications among health care professionals and
patients,
including patient education, self-management, and follow-up plans;
(4)
the educational, wellness, and clinical management protocols and tools used by
the
care
management organization, including management guideline materials for health
care
professionals
to assist in patient-specific recommendations;
(5)
process and outcome measures to provide performance feedback for health care
professionals
and information on the quality of care, including patient satisfaction and
health
status
outcomes;
(6)
payment methodologies to align reimbursements and create financial incentives
and
rewards
for health care professionals to establish management systems for chronic
conditions, to
improve
health outcomes, and to improve the quality of care, including case management
fees,
pay
for performance, payment for technical support and data entry associated with
patient
registries,
the cost of staff coordination within a medical practice, and any reduction in
a health
care
professional's productivity;
(7)
payment methodologies to any care management organization implementing a
chronic
care
management program which would put the care management organization's fee at
risk if the
management
is not successful in reducing costs; and
(8)
a requirement that the data on enrollees in any chronic care management program
implemented
pursuant to this section be shared, to the extent allowable under federal law,
and in a
format
that does not provide any patient-identifiable information, with the director
in order to
inform
the health care reform initiatives.
(d)
No later than January 1, 2009 the secretary of health and human services shall
ensure
access
to a healthy Rhode Island chronic care management program consistent with the
program
criteria
developed by the director under this section for appropriate persons receiving
any type of
medical
assistance benefits through the department of human services, the department of
mental
health,
retardation and hospitals, the department of children, youth and families, or
the
department
of elderly affairs with such chronic care management program to be available to
all
such
persons by July 1, 2009. Any contract to provide medical assistance benefits
may allow the
entity
to subcontract some chronic care management services to other entities if it is
cost-
effective,
efficient, or in the best interests of the individuals enrolled in the program.
(e)
No later than January 1, 2009 the director of administration shall ensure
access to a
healthy
Rhode Island chronic care management program, consistent with program criteria
developed
by the director under this section,
for appropriate state employees and their dependents
who
receive medical coverage through the health benefit plan for state employees.
(f)
No later than January 1, 2010 the director, in collaboration with the health
insurance
commissioner,
shall require statewide participation by all health insurers, third-party
administrators,
health care professionals, health care facilities and other professionals, in
the
healthy
Rhode Island chronic care management plan, including common outcome measures,
best
practices
and protocols, data reporting requirements, payment methodologies, and other
standards.
(g)
The director shall ensure that the healthy Rhode Island chronic care management
program
is modified over time to comply with the healthy Rhode Island strategic plan
established
under
this chapter.
SECTION
2. This act shall take effect upon passage.
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LC01841/SUB B
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