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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