The 2013 session of the Rhode Island General Assembly has officially,finally, wrapped up. With that, we turn to Rhode Island Public Radio’s health care reporter Kristin Gourlay for a recap of some of the most significant health legislation to pass and not pass and how it might affect you.
DAVE: So much happening in health care now in Rhode Island and nationally – from the implementation of the Affordable Care Act to rising health care prices. Did legislators tackle any of these big issues this session?
KRISTIN: I think the biggest issue they tackled was Rhode Island’s health care system itself – how and what we pay for care, what our health care providers have to tell us about those costs, and how much they have to tell us about mistakes they make. Senator Josh Miller was the key sponsor of the Health Care Reform Act, which passed the General Assembly at the 11th hour. The idea behind it is to help Rhode Island move from a health care system where you pay for each service—every diagnostic test, every specialist visit—to one where doctors get paid to keep people healthy, say a certain amount a month per patient, as just one example. The legislation gives the state’s commissioner of health insurance the power to monitor this transition, although what that will actually look like remains to be seen.
The bill also directs the Health Planning and Accountability Advisory Council – which is a group the legislature set up – to review certain hospital prices and payments and make recommendations for keeping costs down. And it will require some more reporting from hospitals about medical errors.
DAVE: But why did we need this legislation? Aren’t there other initiatives going on at the state level to tackle health care costs? The health insurance commissioner, for instance, has tried to keep the lid on insurance premium increases.
KRISTIN: You’re right. You may be hearing more about this new model called “patient-centered medical homes,” which are growing in popularity in Rhode Island. There are now more than 30 medical practices enrolled in the commissioner’s patient-centered medical home program. They provide more coordinated primary care. And they’re supposed to help bring down costs by treating chronic diseases before they get serious enough to require a much more expensive hospitalization. This legislation, I think, is trying to coordinate some of these efforts.
DAVE: What other health legislation made it to the governor’s desk that could have some real impacts in the lives of Rhode Islanders?
KRISTIN: I think there are a few. First, this year’s budget calls for moving about 6500 parents off of Rite Care. That’s Rhode Island’s Medicaid program, or health care for the poor. They’re going to have to find commercial insurance on the new health benefits exchange. Translation: thousands of people who got free or low cost government-funded health insurance will now have to go buy their own coverage on the online health insurance marketplace that goes live October 1st.
DAVE: With no more federal or state assistance whatsoever?
KRISTIN: Not exactly. Many will still qualify for federal help paying monthly premiums. And the state budget includes some money to help them with co-pays and deductibles. But some of the advocacy organizations I spoke with say it won’t be enough. They’re worried that some of the most vulnerable, low income Rhode Islanders will be smacked with health care costs they’ve never had before. That said, legislators also got rid of the monthly premium for kids in Rite Care. That’ll affect about 5600 families.
What’s interesting about this is that at the same time that Rhode Island is shrinking the number of people who once qualified for Medicaid, it’s also expanding it – under the Affordable Care Act – to those who never have before, including low income adults without children.
DAVE: Speaking of families and children, the governor also signed legislation expanding the temporary disability insurance program for things like caring for a new child or taking care of a sick family member (the temporary caregiver insurance bill). Also, Kristin, it looks like some bills related to drug abuse made it to the governor’s desk. Tell us about the ban on synthetic drugs, for example.
KRISTIN: Sure. This one was proposed by Attorney General Peter Kilmartin, and the governor did sign it into law. It bans synthetic marijuana and bath salts, as well as some of the chemical compounds used to make them. These drugs are typically found in convenience stores and gas stations under names like K2 and spice. And while there’s a federal law banning them, manufacturers and retailers have found ways around that by using different chemical formulations. This law aims to put the kibosh on that. Health officials say these drugs are dangerous – they’ve sent dozens of people, particularly young people – to the hospital. And they’re potentially addictive.
DAVE: Sticking with that topic, addictive drugs, the governor also approved a bill allowing more electronic prescriptions. So doctors can now submit so-called e-prescriptions to pharmacies for controlled substances?
KRISTIN: That’s right. This bill basically updated some old language in the law. The effect could be two-fold: one is that it should make forging prescriptions for drugs like OxyContin or Percocet more difficult. The other is that these e-prescriptions could eventually be linked to the state’s prescription monitoring program, which tries to spot addictive behavior.
DAVE: How did hospitals and health care providers fare in this legislative session, Kristin?
KRISTIN: The state’s nurses are pretty happy, actually. Governor Lincoln Chafee just signed a law removing whatever barriers there might have been preventing nurse practitioners from doing everything their licenses allow them to, and that they’ve trained for. That could end up being really important as more Rhode Islanders get health insurance and need primary care – because doctors are increasingly relying on nurse practitioners to see and treat patients as part of their practices.
DAVE: And for hospitals – lawmakers upped the amount of money they receive for taking care of people without insurance this year, I see.
KRISTIN: Yes, but they froze the reimbursement rate from Medicaid. So it’s a mixed bag for hospitals.
DAVE: Anything else catch your eye this session?
KRISTIN: Well, yes – I’ve got an update on an issue I covered earlier this year. A legislative committee came up with some recommendations for diverting chronic alcohol and drug abusers away from the state’s emergency rooms and into a kind of sobering center instead. The point was not only to bring down the high cost of taking the same few people to the hospital in an ambulance multiple times a year. It was also to find a better way, a better place to treat them and connect them to the services they need to get sober and get off the streets.
So, the legislature ponied up a little money for a pilot project. And the department of behavioral health is asking for an organization to submit a blueprint for what such a pilot would look like.
DAVE: It’s been a busy session! Thanks, Kristin.
KRISTIN: My pleasure, Dave.
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