Title 42
State Affairs and Government

Chapter 14.6
Rhode Island All-Payer Patient-Centered Medical Home Act

§ 42-14.6-2. Legislative purpose and intent.

(a) The general assembly recognizes that patient-centered medical home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults. The patient-centered medical home is a healthcare setting that facilitates partnerships between individual patients, and their personal physicians, physician assistants and advanced practice nurses, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. The goals of the patient-centered medical home are improved delivery of comprehensive primary care and focus on better outcomes for patients, more efficient payment to physicians and other clinicians and better value, accountability and transparency to purchasers and consumers. The patient-centered medical home changes the interaction between patients and physicians and other clinicians from a series of episodic office visits to an ongoing two-way relationship. The patient-centered medical home helps medical care providers work to keep patients healthy instead of just healing them when they are sick. In the patient-centered medical home patients are active participants in managing their health with a shared goal of staying as healthy as possible.

(b) The patient-centered medical home has the following characteristics:

(1) Emphasizes, enhances, and encourages the use of primary care;

(2) Focuses on delivering high quality, efficient, and effective healthcare services;

(3) Encourages patient-centered care, including active participation by the patient and family, or designated agent for healthcare decision-making, as appropriate in decision-making and care plan development, and providing care that is appropriate to the patient’s individual needs and circumstances;

(4) Provides patients with a consistent, ongoing contact with a personal clinician or team of clinical professionals to ensure continuous and appropriate care for the patient’s condition;

(5) Enables and encourages utilization of a range of qualified healthcare professionals, including dedicated care coordinators, in a manner that enables providers to practice to the fullest extent of their license;

(6) Focuses initially on patients who have or are at risk of developing chronic health conditions;

(7) Incorporates measures of quality, resource use, cost of care, and patient experience;

(8) Ensures the use of health information technology and systematic follow-up, including the use of patient registries; and

(9) Encourages the use of evidence-based health care, patient decision-making aids that provide patients with information about treatment options and their associated benefits, risks, costs, and comparative outcomes, and other clinical decision support tools.

(c) The general assembly recognizes that Rhode Island is a national leader in all-payer patient-centered medical homes through a model developed by providers and financed through the voluntary participation of insurers. The continuation of this model, developed by the Rhode Island chronic care sustainability initiative, is recognized as critical to the future structure of the Rhode Island primary care delivery system. The general assembly also recognizes that the model created through this legislation is not the only model for patient-centered medical homes and in no way seeks to limit the innovation of providers and insurers in the future.