OHIC REGULATION 2 – POWERS AND DUTIES OF THE OFFICE OF THE HEALTH INSURANCE COMMISSIONER

Regulation Authority:

R.I. Gen. Laws §§ 42-14.5-1 et seq., 42-14-5, 42-14-17 and 42-35-1 et seq.

Purpose and Reason:

The Proposed Amendments and the Adopted Regulation are intended to: identify the purposes and general goals of the Affordable Health Insurance requirements of Section 9 of Regulation 2; clarify that the Commissioner of OHIC may take into consideration the Affordable Health Insurance requirements of Section 9 of Regulation 2 with respect to health insurance rate filings, and in connection with the discharge of any of the duties of OHIC; and identify specific payment strategies for health insurers, implementation of which will be considered by the Commissioner in determining whether a health insurer is enhancing the cost effective utilization of appropriate services. Those specific payment strategies are: financial support for primary care services, financial support for the Patient Centered Medical Home Initiative, electronic health records incentive payments, and cost-effective contracting with hospitals. The Proposed Amendments and the Adopted Regulation also are intended to provide for the review of the payment strategies by the Health Insurance Advisory Council every two years, and to provide for an effective date for the amendments, and to establish an applicability provision. The remainder of the Proposed Amendments and the Adopted Regulation are changes to grammar and to form. A public hearing on the Proposed Amendments was held on May 4, 2011. Written comments were received by OHIC. The following summarizes the comments received by OHIC concerning the Proposed Amendments, OHIC’s response to those comments, and the changes to the Proposed Amendments that are reflected in the Adopted Regulation.