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:

1. The Proposed Amendments add a new subsection (10(d)(3)) titled “Measure Alignment” to Section 10, designed to accomplish the following: • Measure Alignment. For the purposes of reducing administrative burden on health care providers, ensuring consistency in the use of quality measures, and improving the quality of health care, health insurers will be required to adhere to the use of “Aligned Measure Sets” in contracts with health care providers that incorporate quality measures into the terms of payment. • Annual Review of Aligned Measure Sets. For purposes of ensuring that the Aligned Measure Sets reflect changes to clinical best-practices, changes to measures adopted by national or subnational measure stewards, and support the present needs and interests of residents of the state and the local health care system, the proposed amendments establish an annual process to reassess the Aligned Measures Sets. No changes were made to Section 10(d)(3) after public comment. 2. The Proposed Amendments to Section 10(d)(4) titled “Hospital Contracts” require health insurer contracts with hospitals to use the Aligned Measure Set for hospitals, revise the hospital price inflation cap to be fixed at percentage changes in the US All Urban Consumer All Items Less Food and Energy Consumer Price Index (CPI-U) plus 1%, instead of the existing schedule of CPI-U plus a depreciating additive factor, and deletes reference to the prohibition that quality payments cannot enter in hospital base payment rates for succeeding years. No changes were made to section 10(d)(4) after public comment. 3. The Proposed Amendments to Section 11 revise how the Administrative Simplification Task Force is convened. Two sentences were deleted from sections 11(a)(1) and 11(a)(2) based on public comment. Deletion of these sentences better aligns the language of these subsections with the proposed and adopted changes to the process of convening the Administrative Simplification Task Force. The remainder of changes are non-substantive changes to grammar and form.