Updated March 25 at 2:33pm

OHIC proposes new conditions for decision on 2012 rate requests


CRANSTON – R.I. Health Insurance Commissioner Christopher F. Koller issued a notice of new proposed conditions relating to the rate factor decision for the 2012 rate requests by Rhode Island’s commercial health insurers.

Public comment on the new proposed conditions, which were announced Wednesday, will be accepted no later than the close of business on Friday, July 20.

The new proposed conditions are related to six contract conditions imposed in July 2010 to support OHIC’s affordability standard to “work toward comprehensive payment reform across the delivery system.”

Koller is seeking to make changes to these conditions as part of the current small and large group commercial health insurance rate factor decisions docket now underway.

Koller has proposed making changes based on evidence of compliance and policy effects.

For instance, under “Quality Incentives,” Koller found that while generally, the quality incentives had increased, “the programmatic details related to their quality incentives” had not been worked out at the time of the contract signing.

To remedy that, Koller proposed adding the following language (in italic): “The measures, performance levels, payment levels, and payment mechanisms must be articulated in the contract and any payments must occur after the measurement period.”

Another proposed change regards “Transparency,” in which Koller has added the following paragraph: “Any contractual language forbidding the disclosure of contractual or payment information shall have: (1) a specific exemption for information shared to or by providers in shared risk arrangements similar to those described in condition one who seek such information for the purposes of improved care coordination and (2) an affirmative obligation of the issuer to provide such information to those providers when requested.”

Koller had previously said that his decision on rate requests would be issued by the end of July. The process for the new proposed conditions would appear to delay that decision until sometime in August.

To view the proposed new conditions, visit www.ohic.ri.gov.


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