Connecticut Seal

General Assembly

Amendment

 

January Session, 2011

LCO No. 8493

   
 

*HB0630808493SRO*

Offered by:

 

SEN. RORABACK, 30th Dist.

 

To: Subst. House Bill No. 6308

File No. 868

Cal. No. 592

After the last section, add the following and renumber sections and internal references accordingly:

"Sec. 501. (NEW) (Effective July 1, 2011) (a) The Comptroller shall establish a health care provider committee that shall develop recommended clinical care and safety guidelines for use by participating health care providers. The committee shall choose from nationally and internationally recognized guidelines for the provision of care, including guidelines for hospital safety and the inpatient and outpatient treatment of particular conditions. The committee shall continually assess the quality of evidence relevant to the costs, risks and benefits of treatments described in such guidelines. The health care provider committee shall forward their recommended clinical care and safety guidelines to the Comptroller in accordance with such time and format requirements as may be prescribed by the Comptroller. The health care provider committee shall include both health care consumers and health care providers.

(b) Health care providers participating in the partnership plan shall receive confidential reports comparing their practice patterns with those of their peers. Such reports shall provide information about opportunities for appropriate continuing medical education.

(c) Notwithstanding any provision of the general statutes, there shall be no monetary liability on the part of, and no cause of action for damages shall arise against, a participating provider for a partnership plan member's injury caused by such provider's provision of care when such care was consistent with guidelines approved by the Comptroller. The Comptroller shall establish and implement a process for providing a member with no-fault compensation for injuries sustained by such member notwithstanding the fact that the provider's provision of care was consistent with guidelines approved by the Comptroller. Exemption from liability shall not apply to injuries that result from: (1) A mistaken determination by the provider that a particular guideline applied to a particular patient, where such mistaken determination is caused by the provider's negligence or intentional misconduct, or (2) a failure to properly follow a particular guideline where such failure is caused by the provider's negligence or intentional misconduct.

(d) The Comptroller, in consultation with the health care provider committee, shall approve quality of care standards for the care of particular medical conditions. Such standards may reflect outcomes over the entire care cycle for each health care condition, adjusted for patient risk and general consistency of care with approved guidelines as well as other factors. Providers who meet or exceed quality of care standards for a particular medical condition shall be publicly recognized by the Comptroller in such manner as the Comptroller determines appropriate. Such recognition shall be effectively communicated to partnership plan members, including those who have been diagnosed with the particular medical condition for which recognition has been extended. Such communication to members shall be in multiple forms and reflect consideration of diversity in primary language, general and health literacy levels, past health-information-seeking behaviors, and computer and Internet use among members.

(e) The Comptroller shall develop procedures that require hospitals and their medical staffs, physicians, nurse practitioners, and other participating health care providers to engage in periodic reviews of their quality of care. The purpose of such reviews shall be to develop plans for quality improvement. Such reviews shall include the identification of potential problems manifesting as adverse events or events that could have resulted in negative patient outcomes. As appropriate, such reviews shall incorporate confidential consultation with peers and colleagues, opportunities for continuing medical education, and other interventions and supports to improve performance. To the maximum extent permissible, such reviews shall incorporate existing peer review mechanisms. Any review conducted in accordance with the provisions of this subsection shall be subject to the protections afforded by section 19a-17b of the general statutes.

(f) The Comptroller, in consultation with those hospitals serving partnership plan members, shall develop hospital safety standards that shall be implemented in such hospitals. The Comptroller shall establish monitoring procedures and sanctions that ensure compliance by each participating hospital with such safety standards and may establish performance incentives to encourage hospitals to exceed such safety standards.

(g) The Comptroller may provide participating providers with information about prescription drugs, medical devices, and other goods and services used in the delivery of health care. Such information may address emerging trends that involve utilization of goods and services that, in judgment of the board, are less than optimally cost effective. The Comptroller may furnish participating providers with free samples of generic or other prescription drugs.

(h) The Comptroller may develop and implement procedures and incentives that encourage participating providers to furnish and partnership plan members to obtain appropriate evidenced-based health care. "