Chapter 08-207

Chapter 207

2008 -- H 7465 SUBSTITUTE A

Enacted 07/04/08

A N A C T

RELATING TO HEALTH AND SAFETY -- HEALTH CARE QUALITY PROGRAM

Introduced By: Representatives McNamara, Lewiss, and Naughton

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.

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.

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.

=======

LC01209/SUB A/3

=======