RI's health care system is 'in critical condition.' This bill package aims to stop the bleeding.

PROVIDENCE – With Rhode Island facing an "alarming" primary care doctor shortage, hospitals and nursing homes struggling to stay staffed and dentists in the long line of medical professionals clamoring for higher reimbursements, Senate leaders are seeking to make their mark in the health care arena this year.

On Tuesday, they unveiled a 25-bill package that seeks to make Rhode Island a more attractive place for medical professionals to work by closing the pay gap between doctors here and their counterparts in Massachusetts and Connecticut, and by offering to pay up to $70,000 a year in medical school tuition.

Another bill in the package would have the state – on a one-time basis – use untapped COVID relief dollars to pay off the medical debts of Rhode Islanders with incomes of up to 400% of the federal poverty level, or $60,240 for an individual, $81,760 for a couple and more for larger families.

Senate Majority Leader Ryan Pearson acknowledged it is not yet known how much this debt erasure would cost, and how many people with medical debts that equal at least 5% of their income would qualify.

But "the opportunity here for Rhode Island is to purchase (the debt) at the price that you would buy it in bulk ... which is typically pennies on the dollar," he said citing a newly announced program in Arizona that will use $30 million in federal relief dollars to pay off up to $2 billion in medical bills. Connecticut announced a similar program last month.

More broadly, Senate President Dominick Ruggerio said, “Few issues are as important as health care, and right now, our health care system is in critical condition."

The symptoms: "For too many people in our state, care is too expensive or too difficult to get ... We know that many health care providers are feeling enormous strain due to many factors. Our community hospitals, including Fatima in my district, are facing difficult circumstances."

What is in the Senate health care package?

Among the highlights of the far-reaching Senate package:

• Requiring commercial insurers to pay hospitals, physicians and others in the medical field in Rhode Island – including nurses, physical therapists and social workers – roughly the same "average" rates as their counterparts in Massachusetts and Connecticut are paid for the same services by 2028.

• Committing the state to paying up to $70,000 each year for four years towards the medical school tuition of a limited number – and diverse mix – of students studying to become primary care doctors, and up to $47,000-a-year for those in two-year schools to become nurse practitioners and physicians assistants. With a projected four-year cost of $3.58 million, it would award up to five new medical school scholarships, five new nurse practitioner scholarships and five new physician assistant scholarships per academic year. And for every two-year period they practice in Rhode Island, one year of their tuition debt would be canceled, with the goal of keeping newly minted doctors in the state for at least eight years.

• Allowing state Medicaid to pay for the clinical time of graduate student interns in the mental-health field.

A fourth bill in the Senate package seeks leverage over the cost of prescription drugs by creating a "Rhode Island Drug Cost Review Commission."

With its extraordinary powers, this five-member appointed commission could "impose a cost or payment limit on payors for a prescription drug," and potentially keep certain brands out of the market.

Putting aside what a doctor might recommend, this commission could take into account whether a particular prescription drug "has lead or shall lead to excess costs for health care systems in the state; the price at which therapeutic alternates have been/shall be sold in the state; and the relative clinical merits of the product under review compared to therapeutic alternates."

In the event the commission finds that the spending on a particular drug "creates excess costs for payors and consumers," the commission can establish the level of reimbursement that would be billed and paid up and down the chain.

"Instances of failure to bill and pay at commission-established levels ... shall be referred to the office of the attorney general," the bill reads.

More: The customs, quirks and unspoken rules that really decide how bills become law in RI

How much will the state be willing to spend to address health care shortages?

In the ways of the Rhode Island legislature, it's the House – not the Senate – that crafts the big state budget bill each year, so any bill with a price tag attached would require the backing of House leaders. And several of the bills in this Senate package come with potentially hefty price tags.

But there is general agreement that staffing shortages across the health care spectrum – and a shortage of primary care doctors, in particular – has reached crisis proportions.

The legislation lays out the problem, the reasons for it and the urgent need for the state to make the investments.

"Many primary care health care providers are retiring early and many more are approaching retirement age," the legislation reads. "Fewer students are going into primary care as a profession due to lower salaries, high student loans and increasing administrative burden leading to provider burnout."

The legislation also says that the difficulty primary care practices encounter hiring nurses, medical assistants, behavioral health clinicians and other staff is leading to "even higher burnout among primary care providers" at a time when the state's aging population "requires more medical care."

What about Medicaid?

Medicaid already eats up 30.45% of the state budget. What can the state do?

Gov. Dan McKee went part-way in the $13.7-billion budget he proposed to legislators in January.

He proposed a whopping $135-million boost in Medicaid payments to some service providers but not others, including the primary care doctors Rhode Island is losing at a rapid pace.

McKee asked lawmakers to boost the Medicaid reimbursement rates paid those who provide mental-health, substance-abuse and home health care services by $51.7 million, and fill gaps in required early-intervention services for young children with developmental delays for $3.8 million.

He wants to steer another $79.7 million into what is being described as a new "Certified Community Behavioral Health Clinics model" to provide a "de-institutionalized, comprehensive range of behavioral health, medical screening and monitoring, and social services to particularly vulnerable populations with complex needs."

Asked why the administration is not seeking to boost the Medicaid reimbursement rates for primary care doctors and clinicians, Richard Charest, the state's secretary of health and human services, told The Journal in January: the state's insurance commissioner was evaluating primary care reimbursement rates.

"That hasn't been done yet," he said.

Asked Wednesday about the Senate proposals, McKee's office on Wednesday said the governor's team "look[s] forward to reviewing the Senate’s legislative package in full. Ensuring better health outcomes for all Rhode Islanders is one of Governor’s McKee’s three top priorities for our state.

"We’re ready to work with stakeholders and our partners in the General Assembly to address the challenges facing Rhode Island’s health care system head on," spokeswoman Olivia DaRocha said.

House Speaker K. Joseph Shekarchi was non-committal, but he "congratulate[d] the Senate on the hard work that is reflected in this health care package" and promised that after Senate approval, "the House will be certain to give careful consideration to all the bills.”

From telemedicine to surprise billing - other bills in the package

Other bills in the package cover a lot of other ground, from professional licensing to telemedicine to a long-sought ban on "surprise" billing. They would:

• Allow out-of-state doctors, who are credentialed in their home states, to provide remote telehealth services to patents in Rhode Island – as was the case during the pandemic – as long as they register here and abide by certain basic requirements.

• Allow Rhode Island to open doors for a number of other types of health care professional, from physician assistants to occupational therapists, audiologists and social workers to treat and/or work with Rhode Islanders via licensing compacts with other states.

• Prohibit hospitals and other health care providers from reporting medical debt to consumer reporting agencies.

Absent from the Senate leadership package is a bill – championed by a wide array of advocacy groups and unions – to levy a new 2% assessment on health insurance premiums to raise a projected $20 million in state revenue to create an "affordability fund."

This article originally appeared on The Providence Journal: RI Senate pitches huge health care bill package - what's in it