Permits a physician or an optometrist to dispense and sell therapeutic contact lenses in-office, as long as dispensing the medication contained in the lenses is within his or her scope of practice.
Health Care Providers
Requires every health care provider to track and report quality information at least annually according to Department of Public Health regulations.
Authorizes optometrists to use and prescribe certain therapeutic medications, including the in-office dispensing and sale of therapeutic contact lenses, as long as the medication contained within the lenses is within the provider's designated scope of practice.
Prohibits certain contracting practices between insurance carriers and health care providers including the following: provisions that guarantee a health care provider the right to participate in a select network or tiered network plan; requirements that all members of a provider group be included in the same tier in a tiered network plan or all be included in a select network plan; requiring provider participation in a new select or tiered network plan without granting providers the right to opt out of the new plans; requiring or permitting carriers or providers to alter contracts based on agreements with other carriers and providers; and requiring or permitting carriers to make supplemental payments without first publicly disclosing the amount and purpose of each such supplemental payment to the Insurance Commissioner.
Instructs the Division of Health Care Finance and Policy (DHCFP), in consultation with the Division of Insurance, to establish regulations directing hospitals to calculate and report all costs, including inpatient and outpatient costs and direct and indirect costs. Calculations must include costs and cost trends for labor, debt-related expenses, advertising and marketing, insurance, health information technology, management, research, academic costs, contributions, and all business operation costs. Before adopting final regulations, DHCFP must consult with designated stakeholders.
Directs the Secretary of Health and Human Services to organize a working group consisting of many state agencies and health care community stakeholders to identify ways to streamline health care administration requirements and reduce reporting requirements through the use of a single all-payer database.
The group must issue a report to the legislature by April 1, 2011 identifying steps each agency will take to collectively simplify administrative and reporting requirements.
Establishes a special commission to study the financial needs of community hospitals, with a focus on use of technology, maintaining adequate facilities, meeting the health care needs of the general population in the next decade and determining potential sources of capital to meet those needs. The commission is also directed to evaluate the role of public programs, payments, and regulations in supporting capital accumulation, and make recommendations to the legislature to advance the ability of community hospitals to meet the expected demand. The commission must hold hearings as part of its investigation and submit its findings in a report to the legislature by December 31, 2011.
Directs the Division of Medical Assistance to revise the Independent Clinical Laboratory Manual to include licensed substance abuse treatment programs as authorized prescribers of random substance treatment-related urine drug screens.
Requires that the Division of Health Care Finance and Policy (DHCFP) encourage providers and payers to adopt a payment system on a bundled payment, rather than fee-for-service, basis to reduce costs and improve quality and coordination of health care services. DHCFP must assist providers and payers to adopt such a payment system by making technical support available to them. DHCFP must also examine existing and proposed bundled payment models and publish results of research, study the effects of federal programs that promote bundled payment systems, and identify financial resources that may become available to providers while they implement bundled payment systems. The statute encourages DHCFP to implement pilot bundled payment programs before April 1, 2011 for at least 2 acute conditions or procedures where health benefit payers will reimburse health care providers for inpatient services, as well as certain pre- and post-inpatient stay, on a bundled payment basis. DHCFP is also encouraged to implement additional pilot bundled payment programs for at least 2 chronic conditions by July 1, 2011. DHCFP must file reports with the legislature detailing the efforts it undertakes to support providers and payers to implement bundled payment programs and the progress it makes toward implement the encouraged pilot programs.
Provides that a health care provider may contract to provide supplemental funding to a health insurance carrier to be used to issue a premium reimbursement or other form of refund for eligible individuals and small groups currently enrolled in all health benefit plans under the carrier. The Division of Insurance (DOI) must issue a public report listing participating providers and the estimated refunds for individuals and small groups.
Creates a special commission on provider price reform to study rising cost trends of health insurance and the impact of reimbursement rates that health insurers pay to providers. The commission must examine policies that reduce disparities in provider reimbursement rates while enhancing competition, fairness, and cost efficiency in the health care market. Any recommendation the commission offers to the legislature must be consistent with recommendations of the Special Commission on the Health Care Payment System established in Section 44 of Chapter 305 of the Acts of 2008. The commission must consult with state agencies and other organizations with expertise in health care reform and a reasonable number of affected parties before making recommendations. The commission must submit a report of its findings and recommendations to the legislature by September 30, 2011.