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Promotion of the patient-centered medical home - R.I. Gen. Laws Ann. § 42-14.6-4

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A “patient-centered medical home collaborative” must convene for the purpose of providing the health insurance commissioner and secretary of the executive officer of human services with recommendations for a payment system “that requires all health insurers to make per-person care coordination payments to patient-centered medical homes [(PCMHs)], 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.”

Payments for care coordination must “be consistent across insurers and [PCMHs]” and will be provided in addition to other incentive payments (e.g. quality incentive payments). The commissioner must “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” when establishing the criteria for care coordination payments.

The collaborative must, by January 1, 2013, consider other payment reforms for use by PCHMs including those that (1) reward providers of high-quality and low-cost care; (2) provide incentives to enrollees that receive care from high-quality and low-cost providers; (3) encourage provider collaboration as a means of reducing cost-shifting; and (4) incentivize the provision of care in “the least restrictive, most appropriate setting.”

The collaborative must provide the secretary with recommendations “regarding the designation of [PCMHs], 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 [PCMHs].”

The care coordination payment system must be implemented by July 1, 2016 and will continue dependent upon the results of periodic evaluations.

Current as of June 2015