§42-7.2-16  Medicaid System Reform 2008. –


Published: 2015

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TITLE 42

State Affairs and Government

CHAPTER 42-7.2

Office of Health and Human Services

SECTION 42-7.2-16



   § 42-7.2-16  Medicaid System Reform 2008.

–

(a) The executive office of health and human services, in conjunction with the

department of human services, the department of children, youth and families,

the department of health and the department of behavioral healthcare,

developmental disabilities, and hospitals, is authorized to design options that

further the reforms in Medicaid initiated in 2008 to ensure that the program:

utilizes competitive and value based purchasing to maximize the available

service options, promotes accountability and transparency, and encourages and

rewards healthy outcomes, independence, and responsible choices; promotes

efficiencies and the coordination of services across all health and human

services agencies; and ensures the state will have a fiscally sound source of

publicly-financed health care for Rhode Islanders in need.



   (b) Principles and Goals. In developing and

implementing this system of reform, the executive office of health and human

services and the four (4) health and human services departments shall pursue

the following principles and goals:



   (1) Empower consumers to make reasoned and cost-effective

choices about their health by providing them with the information and array of

service options they need and offering rewards for healthy decisions;



   (2) Encourage personal responsibility by assuring the

information available to beneficiaries is easy to understand and accurate,

provide that a fiscal intermediary is provided when necessary, and adequate

access to needed services;



   (3) When appropriate, promote community-based care solutions

by transitioning beneficiaries from institutional settings back into the

community and by providing the needed assistance and supports to beneficiaries

requiring long-term care or residential services who wish to remain, or are

better served in the community;



   (4) Enable consumers to receive individualized health care

that is outcome-oriented, focused on prevention, disease management, recovery

and maintaining independence;



   (5) Promote competition between health care providers to

ensure best value purchasing, to leverage resources and to create opportunities

for improving service quality and performance;



   (6) Redesign purchasing and payment methods to assure fiscal

accountability and encourage and to reward service quality and

cost-effectiveness by tying reimbursements to evidence-based performance

measures and standards, including those related to patient satisfaction; and



   (7) Continually improve technology to take advantage of

recent innovations and advances that help decision makers, consumers and

providers to make informed and cost-effective decisions regarding health care.



   (c) The executive office of health and human services shall

annually submit a report to the governor and the general assembly describing

the status of the administration and implementation of the Medicaid Section

1115 demonstration waiver.



History of Section.

(P.L. 2008, ch. 100, art. 17, § 2; P.L. 2012, ch. 241, art. 18, § 1;

P.L. 2015, ch. 141, art. 5, § 20.)

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