§ 23-17.22-3 Healthy Rhode Island chroniccare management program. – (a) The director shall create criteria for the healthy Rhode Island chroniccare management program as provided for in this section.
(b) The director shall include a broad range of chronicconditions in the healthy Rhode Island chronic care management program.
(c) The healthy Rhode Island chronic care management programshall be designed to include:
(1) A method involving the health care professional inidentifying eligible patients, including the use of a chronic care informationsystem established pursuant to this section, an enrollment process whichprovides incentives and strategies for maximum patient participation, and astandard statewide health risk assessment for each individual;
(2) The process for coordinating care among health careprofessionals, including a process for ensuring that each patient has adesignated primary care physician;
(3) The methods of increasing communications among healthcare professionals and patients, including patient education, self-management,and follow-up plans;
(4) The educational, wellness, and clinical managementprotocols and tools used by the care management organization, includingmanagement guideline materials for health care professionals to assist inpatient-specific recommendations;
(5) Process and outcome measures to provide performancefeedback for health care professionals and information on the quality of care,including patient satisfaction and health status outcomes;
(6) Payment methodologies to align reimbursements and createfinancial incentives and rewards for health care professionals to establishmanagement systems for chronic conditions, to improve health outcomes, and toimprove the quality of care, including case management fees, pay forperformance, payment for technical support and data entry associated withpatient registries, the cost of staff coordination within a medical practice,and any reduction in a health care professional's productivity;
(7) Payment methodologies to any care management organizationimplementing a chronic care management program which would put the caremanagement organization's fee at risk if the management is not successful inreducing costs; and
(8) A requirement that the data on enrollees in any chroniccare management program implemented pursuant to this section be shared, to theextent allowable under federal law, and in a format that does not provide anypatient-identifiable information, with the director in order to inform thehealth care reform initiatives.
(d) No later than January 1, 2009 the secretary of health andhuman services shall ensure access to a healthy Rhode Island chronic caremanagement program consistent with the program criteria developed by thedirector under this section for appropriate persons receiving any type ofmedical assistance benefits through the department of human services, thedepartment of mental health, retardation and hospitals, the department ofchildren, youth and families, or the department of elderly affairs with suchchronic care management program to be available to all such persons by July 1,2009. Any contract to provide medical assistance benefits may allow the entityto subcontract some chronic care management services to other entities if it iscost-effective, efficient, or in the best interests of the individuals enrolledin the program.
(e) No later than January 1, 2009 the director ofadministration shall ensure access to a healthy Rhode Island chronic caremanagement program, consistent with program criteria developed by the directorunder this section, for appropriate state employees and their dependents whoreceive medical coverage through the health benefit plan for state employees.
(f) No later than January 1, 2010 the director, incollaboration with the health insurance commissioner, shall require statewideparticipation by all health insurers, third-party administrators, health careprofessionals, health care facilities and other professionals, in the healthyRhode Island chronic care management plan, including common outcome measures,best practices and protocols, data reporting requirements, paymentmethodologies, and other standards.
(g) The director shall ensure that the healthy Rhode Islandchronic care management program is modified over time to comply with thehealthy Rhode Island strategic plan established under this chapter.
§ 23-17.22-3 Healthy Rhode Island chroniccare management program. – (a) The director shall create criteria for the healthy Rhode Island chroniccare management program as provided for in this section.
(b) The director shall include a broad range of chronicconditions in the healthy Rhode Island chronic care management program.
(c) The healthy Rhode Island chronic care management programshall be designed to include:
(1) A method involving the health care professional inidentifying eligible patients, including the use of a chronic care informationsystem established pursuant to this section, an enrollment process whichprovides incentives and strategies for maximum patient participation, and astandard statewide health risk assessment for each individual;
(2) The process for coordinating care among health careprofessionals, including a process for ensuring that each patient has adesignated primary care physician;
(3) The methods of increasing communications among healthcare professionals and patients, including patient education, self-management,and follow-up plans;
(4) The educational, wellness, and clinical managementprotocols and tools used by the care management organization, includingmanagement guideline materials for health care professionals to assist inpatient-specific recommendations;
(5) Process and outcome measures to provide performancefeedback for health care professionals and information on the quality of care,including patient satisfaction and health status outcomes;
(6) Payment methodologies to align reimbursements and createfinancial incentives and rewards for health care professionals to establishmanagement systems for chronic conditions, to improve health outcomes, and toimprove the quality of care, including case management fees, pay forperformance, payment for technical support and data entry associated withpatient registries, the cost of staff coordination within a medical practice,and any reduction in a health care professional's productivity;
(7) Payment methodologies to any care management organizationimplementing a chronic care management program which would put the caremanagement organization's fee at risk if the management is not successful inreducing costs; and
(8) A requirement that the data on enrollees in any chroniccare management program implemented pursuant to this section be shared, to theextent allowable under federal law, and in a format that does not provide anypatient-identifiable information, with the director in order to inform thehealth care reform initiatives.
(d) No later than January 1, 2009 the secretary of health andhuman services shall ensure access to a healthy Rhode Island chronic caremanagement program consistent with the program criteria developed by thedirector under this section for appropriate persons receiving any type ofmedical assistance benefits through the department of human services, thedepartment of mental health, retardation and hospitals, the department ofchildren, youth and families, or the department of elderly affairs with suchchronic care management program to be available to all such persons by July 1,2009. Any contract to provide medical assistance benefits may allow the entityto subcontract some chronic care management services to other entities if it iscost-effective, efficient, or in the best interests of the individuals enrolledin the program.
(e) No later than January 1, 2009 the director ofadministration shall ensure access to a healthy Rhode Island chronic caremanagement program, consistent with program criteria developed by the directorunder this section, for appropriate state employees and their dependents whoreceive medical coverage through the health benefit plan for state employees.
(f) No later than January 1, 2010 the director, incollaboration with the health insurance commissioner, shall require statewideparticipation by all health insurers, third-party administrators, health careprofessionals, health care facilities and other professionals, in the healthyRhode Island chronic care management plan, including common outcome measures,best practices and protocols, data reporting requirements, paymentmethodologies, and other standards.
(g) The director shall ensure that the healthy Rhode Islandchronic care management program is modified over time to comply with thehealthy Rhode Island strategic plan established under this chapter.
§ 23-17.22-3 Healthy Rhode Island chroniccare management program. – (a) The director shall create criteria for the healthy Rhode Island chroniccare management program as provided for in this section.
(b) The director shall include a broad range of chronicconditions in the healthy Rhode Island chronic care management program.
(c) The healthy Rhode Island chronic care management programshall be designed to include:
(1) A method involving the health care professional inidentifying eligible patients, including the use of a chronic care informationsystem established pursuant to this section, an enrollment process whichprovides incentives and strategies for maximum patient participation, and astandard statewide health risk assessment for each individual;
(2) The process for coordinating care among health careprofessionals, including a process for ensuring that each patient has adesignated primary care physician;
(3) The methods of increasing communications among healthcare professionals and patients, including patient education, self-management,and follow-up plans;
(4) The educational, wellness, and clinical managementprotocols and tools used by the care management organization, includingmanagement guideline materials for health care professionals to assist inpatient-specific recommendations;
(5) Process and outcome measures to provide performancefeedback for health care professionals and information on the quality of care,including patient satisfaction and health status outcomes;
(6) Payment methodologies to align reimbursements and createfinancial incentives and rewards for health care professionals to establishmanagement systems for chronic conditions, to improve health outcomes, and toimprove the quality of care, including case management fees, pay forperformance, payment for technical support and data entry associated withpatient registries, the cost of staff coordination within a medical practice,and any reduction in a health care professional's productivity;
(7) Payment methodologies to any care management organizationimplementing a chronic care management program which would put the caremanagement organization's fee at risk if the management is not successful inreducing costs; and
(8) A requirement that the data on enrollees in any chroniccare management program implemented pursuant to this section be shared, to theextent allowable under federal law, and in a format that does not provide anypatient-identifiable information, with the director in order to inform thehealth care reform initiatives.
(d) No later than January 1, 2009 the secretary of health andhuman services shall ensure access to a healthy Rhode Island chronic caremanagement program consistent with the program criteria developed by thedirector under this section for appropriate persons receiving any type ofmedical assistance benefits through the department of human services, thedepartment of mental health, retardation and hospitals, the department ofchildren, youth and families, or the department of elderly affairs with suchchronic care management program to be available to all such persons by July 1,2009. Any contract to provide medical assistance benefits may allow the entityto subcontract some chronic care management services to other entities if it iscost-effective, efficient, or in the best interests of the individuals enrolledin the program.
(e) No later than January 1, 2009 the director ofadministration shall ensure access to a healthy Rhode Island chronic caremanagement program, consistent with program criteria developed by the directorunder this section, for appropriate state employees and their dependents whoreceive medical coverage through the health benefit plan for state employees.
(f) No later than January 1, 2010 the director, incollaboration with the health insurance commissioner, shall require statewideparticipation by all health insurers, third-party administrators, health careprofessionals, health care facilities and other professionals, in the healthyRhode Island chronic care management plan, including common outcome measures,best practices and protocols, data reporting requirements, paymentmethodologies, and other standards.
(g) The director shall ensure that the healthy Rhode Islandchronic care management program is modified over time to comply with thehealthy Rhode Island strategic plan established under this chapter.
