2021 -- H 6020

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LC001529

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

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A N   A C T

CREATING A SPECIAL LEGISLATIVE COMMISSION TO STUDY RHODE ISLAND'S

PAYMENT AND REIMBURSEMENT FOR HOSPITAL-ACQUIRED CONDITIONS (HAC)

AND HEALTHCARE-ASSOCIATED INFECTIONS (HAI) AND PROVIDE

RECOMMENDATIONS TO ESTABLISH/CLARIFY THE STATE'S POLICY AND

PROCEDURES

     Introduced By: Representatives Vella-Wilkinson, Noret, Ruggiero, Williams, Solomon,
Fogarty, Carson, McGaw, Donovan, and Cortvriend

     Date Introduced: February 26, 2021

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     WHEREAS, In 2016, it was estimated that hospital-acquired conditions (HAC), that the

Centers for Medicare & Medicaid Services (CMS) consider to be avoidable, account for 48,771

adverse patient outcomes, 3,219 deaths and more than $2 billion in excess hospital costs in the

United States; and

     WHEREAS, In response to this growing problem, the CMS implemented the HAC

Reduction Program in order "to improve patients’ safety and reduce the number of conditions

people experience from their time in a hospital" and "to improve patients’ safety and implement

best practices to reduce their rates of infections associated with health care"; and

     WHEREAS, To encourage full participation in this program, hospitals are fined by the

Federal government when they are found to not be fully compliant as measured by "using data on

infections taken from charts, reports, and other sources and reported to the National Healthcare

Safety Network"; and

     WHEREAS, Nine out of Rhode Island's eleven hospitals were penalized a total of $440,000

for charging Medicare for unscheduled readmissions by patients due to HACs and healthcare-

associated infections (HAIs) last year; and

     WHEREAS, Currently in Rhode Island, the required CMS policies pertaining to the HAC

Reduction Program and penalties are not clearly delineated or published, resulting in gross over-

charges to the State's reimbursements for Medicaid patients, and patients with private insurance are

likewise being overcharged; now, therefore be it

     RESOLVED, That a special legislative commission be and the same is hereby created

consisting of nine (9) members; three (3) of whom shall be members of the House of

Representatives, two (2) of whom shall be appointed by the Speaker of the House and one of whom

shall be the Chair of the House Committee on Oversight, or designee; one of whom shall be the

Secretary of Rhode Island's Executive Office of Health and Human Services (EOHHS), or

designee; one of whom shall be a representative of an insurance carrier that offers Medicare

Advantage plans in Rhode Island, to be appointed by the Speaker of the House; one of whom shall

be the President of the Rhode Island Hospital Association, or designee; one of whom shall be the

Director of Provider Network Management and Medical/Payment Policy for Blue Cross & Blue

Shield of Rhode Island, or designee; one of whom shall be the President and Chief Operating

Officer of UnitedHealth Group, or designee; one of whom shall be the Director of HealthSource

RI, or designee.

     In lieu of any appointment of a member of the legislature to a permanent advisory

commission, a legislative study commission, or any commission created by a General Assembly

resolution, the appointing authority may appoint a member of the general public to serve in lieu of

a legislator, provided that the majority leader or the minority leader of the political party which is

entitled to the appointment consent to the member of the general public.

     The purpose of said commission shall be to study Rhode Island's payment and

reimbursement for hospital-acquired conditions (HACs) and healthcare-associated infections

(HAIs) and provide recommendations to establish/clarify the state's policy and procedures

including, but not limited to:

     Current CMS policies, requirements, procedures regarding HAC and HAI reimbursement

     and monitoring;

     The State's regulation of current costs and reimbursements for Medicaid patients in regards

     to HACs and HAIs; and

     The current policy for monitoring and reporting of potential overcharge for private

     insurance patients due to HAC or HAI.

     Forthwith upon passage of this resolution, the members of the commission shall meet at

the call of the Speaker of the House and organize and shall select, from among the legislators, a

chairperson

     Vacancies in said commission shall be filled in like manner as the original appointment.

     The membership of said commission shall receive no compensation for their services.

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     All departments and agencies of the state shall furnish such advice and information,

documentary and otherwise, to said commission and its agents as is deemed necessary or desirable

by the commission to facilitate the purposes of this resolution.

     The Speaker of the House is hereby authorized and directed to provide suitable quarters for

said commission; and be it further

     RESOLVED, That the commission shall report its findings and recommendations to the

House Committee on Oversight no later than January 5, 2022 and said commission shall expire on

March 5, 2022.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

CREATING A SPECIAL LEGISLATIVE COMMISSION TO STUDY RHODE ISLAND'S

PAYMENT AND REIMBURSEMENT FOR HOSPITAL-ACQUIRED CONDITIONS (HAC)

AND HEALTHCARE-ASSOCIATED INFECTIONS (HAI) AND PROVIDE

RECOMMENDATIONS TO ESTABLISH/CLARIFY THE STATE'S POLICY AND

PROCEDURES

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     This resolution would create a nine (9) member special legislative commission whose

purpose it would be to make a comprehensive study of Rhode Island's payment and reimbursement

for hospital-acquired conditions (HACs) and healthcare-associated infections (HAIs) and provide

recommendations to establish/clarify the state's policy and procedures, and who would report back

to the House Oversight Committee no later than January 5, 2022 and whose life would expire on

March 5, 2022.

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