Title 42
State Affairs and Government

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

§ 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(7). 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.