§ 42-14.6-4. Promotion of the patient-centered medical home.
(a) Care coordination payments.
(1) The commissioner and the secretary shall convene a patient-centered medical home collaborative
consisting of the entities described in § 42-14.6-3(5). The commissioner shall require participation in the collaborative by all of the
health insurers described above. The collaborative shall propose, by January 1, 2012,
a payment system, to be adopted in whole or in part by the commissioner and the secretary,
that requires all health insurers to make per-person care coordination payments to
patient-centered medical homes, for providing care coordination services and directly
managing on-site or employing care coordinators as part of all health insurance plans
offered in Rhode Island. The collaborative shall provide guidance to the state healthcare
program as to the appropriate payment system for the state healthcare program to the
same patient-centered medical homes; the state healthcare program must justify the
reasons for any departure from this guidance to the collaborative.
(2) The care coordination payments under this shall be consistent across insurers and
patient-centered medical homes and shall be in addition to any other incentive payments
such as quality incentive payments. In developing the criteria for care coordination
payments, the commissioner shall consider the feasibility of including the additional
time and resources needed by patients with limited English-language skills, cultural
differences, or other barriers to health care. The commissioner may direct the collaborative
to determine a schedule for phasing in care coordination fees.
(3) [Deleted by P.L. 2019, ch. 88, art. 13, § 14.]
(4) Examination of other payment reforms. The commissioner and the secretary shall direct the collaborative to consider additional
payment reforms to be implemented to support patient-centered medical homes including,
but not limited to, payment structures (to medical home or other providers) that:
(i) Reward high-quality, low-cost providers;
(ii) Create enrollee incentives to receive care from high-quality, low-cost providers;
(iii) Foster collaboration among providers to reduce cost shifting from one part of the
health continuum to another;
(iv) Create incentives that health care be provided in the least restrictive, most appropriate
setting; and
(v) Constitute alternatives to fee for service payment, such as partial and full capitation.
(5) The patient-centered medical home collaborative shall examine and make recommendations
to the secretary regarding the designation of patient-centered medical homes, in order
to promote diversity in the size of practices designated, geographic locations of
practices designated and accessibility of the population throughout the state to patient-centered
medical homes.
(b) The patient-centered medical home collaborative shall propose to the secretary for
adoption, standards for the patient-centered medical home to be used in the payment
system. In developing these standards, the existing standards by the national committee
for quality assurance, or other independent accrediting organizations may be considered
where feasible.