Chapter 248
2008 -- H 7352
SUBSTITUTE A AS AMENDED
Enacted 07/05/08
A N A C T
RELATING
TO THE HEALTH AND SAFETY - HEALTHY RHODE ISLAND REFORM ACT
OF
2008
Introduced
By: Representatives Gemma, Fox, Church, Rice, and Schadone
Date Introduced:
February 05, 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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LC01184/SUB A/2
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