What? More health care reform? Isn't the federal government spearheading that? Well, yes, but states are engaged in their own reforms, and Rhode Island's got a particularly big appetite for it.
Enter the Health Care Reform Act of 2013 (which now heads to the governor's desk for signature). It aims, ultimately, to reduce health care costs. Introduced by Rhode Island Senate health committee chair Josh Miller, it continues some work state lawmakers began years ago to help rein in costs and strengthen oversight of health insurers and health care providers.
It's tough to discern what immediate impacts the bill might have, since a lot of its provisions involve conducting studies, monitoring the progress or certain initiatives, developing proposals, etc. That said, here's what the legislative press office says the bill will do:
Move to control costs:
- To control costs and improve quality of care, the legislation would allow the Office of the Health Insurance Commissioner to monitor the transition from traditional fee-for-service payments to alternative models, including global payments, cost sharing, bundled payments other alternative payments to achieve savings for taxpayers.
- Expand the patient-centered medical home program for individuals with chronic health conditions that are high-frequency users through the state employee health benefit plan.
- Require Office of the Health Insurance Commissioner, the Health Department and Lieutenant Governor’s Office to develop a report that proposes standards for the certification of affordable care organizations as an alternative structure for care delivery and payment.
- Review the impact of the current mandated health care benefits on the cost of health insurance for fully insured employers.
- Require the Health Department to review hospital reporting on pay and compensation and financial disclosure and transmit to the Health Planning and Accountability Advisory Council.
- Require the Health Planning and Accountability Advisory Council to review health plans’ rate compliance as it relates to state and federal mental health parity laws.
- Require that all new legislation must contain purposes and objectives of any proposed health benefit mandate, including measurable goals expected to be achieved by the new or expanded benefit mandate.
- Institute a state-by-state comparison of health insurance mandates that includes the extent to which Rhode Island mandates exceed other states benefits.
- Require the Health Planning and Accountability Advisory Council to coordinate a comprehensive review of mental health and substance abuse incidence rates, capacity and potentially high and rising spending.
Addressing Market Power:
- Establish biannual reports on hospital payment variation, including findings and recommendations.
- Require the Health Planning and Accountability Advisory Council to review the Rhode Island health system’s total cost drivers and provide findings, and related recommendations.
- Require the Health Planning and Accountability Advisory Council to examine the volume and spending trends for pediatric inpatient and outpatient services, including the evolving role of intensive care units.
Improve Access and Quality:
- Require the Office of the Health Insurance Commissioner to monitor each health plan’s compliance with the provisions of the federal mental health parity act, including a review of related claims processing and reimbursement procedures.
- Establish additional reporting and transparency requirements for hospitals’ adverse medical errors.
- Establish periodic assessments on projected workforce needs among primary care providers, including supply and demand, recruitment, scope and practice, workforce training, incentives and recommendations.
- Establish standards consistent with the National Committee for Quality Assurance or other accrediting organizations for patient-centered medical homes, whenever feasible, in Rhode Island.