Chapter
114
2008 -- S 2481 SUBSTITUTE B
Enacted 06/30/08
A N A C T
RELATING TO HEALTH
AND SAFETY -- HEALTH CARE QUALITY PROGRAM
Introduced By: Senators C Levesque, Perry, Gibbs, Sosnowski, and Gallo
Date Introduced: February
13, 2008
It is enacted
by the General Assembly as follows:
SECTION
1. Chapter 23-17.17 of the General Laws entitled "Health Care Quality
Program"
is hereby amended by adding thereto the following sections:
23-17.17-9.
Health care quality and value database. – (a) The director shall
establish
and
maintain a unified health care quality and value database to:
(1)
Determine the capacity and distribution of existing resources;
(2)
Identify health care needs and inform health care policy;
(3)
Evaluate the effectiveness of intervention programs on improving patient
outcomes;
(4)
Compare costs between various treatment settings and approaches;
(5)
Provide information to consumers and purchasers of health care;
(6)
Improve the quality and affordability of patient health care and health care
coverage;
(7)
Strengthen primary care infrastructure;
(8)
Strengthen chronic disease management;
(9)
Encourage evidence-based practices in health care.
(b)
The program authorized by this section shall include a consumer health care
quality
and
value information system designed to make available to consumers transparent
health care
price
information, quality information and such other information as the director
determines is
necessary
to empower individuals, including uninsured individuals, to make economically
sound
and
medically appropriate decisions.
(c)
The health care quality steering committee shall serve as the working group to
advise
the
director on the development and implementation of the consumer health care
quality and
value
information system.
(d)
The director, in collaboration with the health insurance commissioner, may
require an
insurer
covering at least five percent (5%) of the lives covered in the insured market
in this state
to
file with the director a consumer health care price and quality information
plan in accordance
with
regulations adopted by the director pursuant to this section.
(e)
The director shall adopt such regulations as are necessary to carry out the
purposes of
this
section and this chapter. The regulations may permit the gradual implementation
of the
consumer
health care quality and value information system over time, beginning with
health care
price
and quality information that the director determines is most needed by
consumers or that
can
be most practically provided to the consumer in an understandable manner. The
regulations
shall
permit insurers to use security measures designed to allow subscribers access
to price and
other
information without disclosing trade secrets to individuals and entities who
are not
subscribers.
The regulations shall avoid unnecessary duplication of efforts relating to
price and
quality
reporting by insurers, health care providers, health care facilities, and
others, including
activities
undertaken by hospitals pursuant to their reporting obligations under this
chapter and
other
chapters of the general laws.
(f)
Requirements for reporting to the health care quality database enumerated in
this
section
and subsequent sections of this chapter shall not apply to insurance coverage
providing
benefits
for:
(1)
hospital confinement indemnity;
(2)
disability income;
(3)
accident only;
(4)
long-term care;
(5)
Medicare supplement;
(6)
limited benefit health;
(7)
specified disease indemnity;
(8)
sickness or bodily injury or death by accident or both; or
(9)
other limited benefit policies.
23-17.17-10.
Reporting requirements for the health care database. -- (a)
Insurers,
health
care providers, health care facilities and governmental agencies shall file
reports, data,
schedules,
statistics or other information determined by the director to be necessary to
carry out
the
purposes of this chapter. The reports required by this chapter shall be
accepted by the director
in
any certification commission for health care information technology
("CCHIT") certified form.
Such
information may include:
(1)
health insurance claims and enrollment information used by health insurers;
(2)
information relating to hospital finance; and
(3)
any other information relating to health care costs, prices, quality,
utilization, or
resources
required to be filed by the director.
(b)
The comprehensive health care information system shall not collect any data
that
contains
direct personal identifiers. For the purposes of this section "direct
personal identifiers"
includes
information relating to an individual that contains primary or obvious
identifiers, such as
the
individual's name, street address, e-mail address, telephone number and social
security
number.
All data submitted to the director pursuant to this chapter shall be protected
by the
removal
of all personal identifiers and the assignment by the insurer to each
subscriber record of a
unique
identifier not linked to any personally identifiable information.
23-17.17-11.
Data collection and information sharing for the health care database. –
(a)
All insurers shall electronically provide to the director in accordance with
standards
and
procedures adopted by the director in regulation:
(1)
their health insurance claims data;
(2)
cross-matched claims data on requested members, subscribers or policyholders;
and
(3)
member, subscriber or policyholder information necessary to determine
third-party
liability
for benefits provided.
(b)
For purposes of all data collection and public reporting of data under this
chapter the
collection,
storage and release of health care data and statistical information that is
subject to the
federal
requirements of the Health Insurance Portability and Accountability Act
("HIPAA") shall
be
governed by the rules adopted in 45 C.F.R. Parts 160 and 164 and other
applicable law.
(c)
All insurers that collect the health employer data and information set (HEDIS)
shall
annually
submit the HEDIS information and such other relevant industry quality standard
measures
as the director requires to the director in a form and in a manner prescribed
by the
director.
(d)
The director shall collaborate with the insurance commissioner within the
department
of
business regulation and all health and human service agencies in the
development of a
comprehensive
health care information system and shall make all data collected pursuant to
this
chapter
available to the insurance commissioner and all relevant government agencies in
furtherance
of the goals of the database set forth herein. The collaboration is intended to
address
the
formulation of a description of the data sets that will be included in the
comprehensive health
care
information system, the criteria and procedures for the development of limited
use data sets,
the
criteria and procedures to ensure the HIPAA compliant limited use data sets are
accessible,
and a
proposed time frame for the creation of a comprehensive health care information
system.
(e)
To the extent allowed by HIPAA and other applicable law, the data shall be
available
as a
resource for insurers, employers, providers, purchasers of health care, and
state agencies to
continuously
review health care utilization, expenditures and performance in Rhode Island
and to
enhance
the ability of Rhode Island consumers and employers to make informed and cost-
effective
health care choices. In presenting data for public access, comparative
considerations
shall
be made regarding geography, demographics, general economic factors and
institutional
size.
(f)
The health care quality steering committee shall advise the director as to the
most
effective
means to make the database accessible to the public for purposes of improving
the
quality
of health care services in Rhode Island.
(g)
The director shall adopt regulations to carry out the provisions of this
chapter,
including
standards and procedures and criteria for the required filing of such claims
data,
eligibility
data, provider files and other information as the director determines to be
necessary to
carry
out the purposes of this section and this chapter.
SECTION
2. This act shall take effect upon passage.
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LC01790/SUB B
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