PATIENT-CENTERED MEDICAL HOME ADVISORY COUNCIL ACT - ENACTMENT — 2014 Pa. Act 198 (historical enacted text)

Historical Act text

SENATE AMENDED
PRIOR PRINTER'S NOS. 2275, 2791, 2869
PRINTER'S NO. 4226
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1655
Session of
2013
INTRODUCED BY BAKER, PICKETT, AUMENT, FRANKEL, GINGRICH, C. HARRIS, DENLINGER, HESS, MILNE, EVERETT, COHEN, MURT, QUINN, CLYMER, HARHART, GABLER AND CUTLER, AUGUST 26, 2013
SENATOR VANCE, PUBLIC HEALTH AND WELFARE, IN SENATE, AS AMENDED, OCTOBER 6, 2014
AN ACT
Establishing the Patient-Centered Medical Home Advisory Council;
providing powers and duties of the council, the Department of
Public Welfare Human Services; and providing for development
of a plan to implement a Statewide medical home model.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Patient-
Centered Medical Home Advisory Council Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Alternative therapy." The term includes, but is not limited
to, chiropractic therapy, biofeedback, acupuncture or massage
therapy.
"Council." The Patient-Centered Medical Home Advisory
Council established by this act.
"Department." The Department of Public Welfare Human
Services of the Commonwealth.
"Health care professional." A person who is licensed,
certified or otherwise authorized or permitted by the law of
this Commonwealth to administer health care in the ordinary
course of business or in the practice of a profession.
"Patient-centered medical home." A team approach to
providing health care that:
(1) is physician-led, led by a nurse practitioner
practicing under a collaborative agreement as required by the
act of May 22, 1951 (P.L.317, No.69), known as The
Professional Nursing Law or led by a physician assistant
practicing under the supervision and direction of a physician
as required by the act of December 20, 1985 (P.L.457,
No.112), known as the Medical Practice Act of 1985;
(2) originates in a primary care setting;
(3) fosters a partnership among the patient, the
personal patient's provider and other health care
professionals and, where appropriate, the patient's family;
(4) utilizes the partnership to access all medical-
health-related services and nonmedical-health-related
services needed by the patient to achieve maximum health
potential; and
(5) maintains a centralized, comprehensive record of all
health related services to promote continuity of care.
"Primary care." Health care that emphasizes a patient's
general health needs and utilizes collaboration with other
health care professionals and consultation or referral as
appropriate to meet the needs identified.
"Primary care physician." Any of the following who provide
primary care and meet certification standards:
(1) a physician who is a family or general practitioner;
(2) a pediatrician;
(3) an internist;
(4) an obstetrician; or
(5) a gynecologist.
"Secretary." The Secretary of Public Welfare Human Services
of the Commonwealth.
"Telemedicine." The use of telecommunication and information
technology in order to provide clinical health care at a
distance.
Section 3. Patient-Centered Medical Home Advisory Council.
(a) Establishment.--The Patient-Centered Medical Home
Advisory Council is established. The council shall advise the
department on how Pennsylvania's Medicaid program can increase
the quality of care while containing costs through the following
Patient-Centered Medical Home model approaches:
(1) Coordinate and provide access to evidence-based
health care services, emphasizing convenient, comprehensive
primary care and including preventive, screening and well-
child health services.
(2) Provide access to appropriate specialty care, mental
health services, inpatient services and any evidence-based
alternative therapies.
(3) Provide quality-driven and cost-effective health
care.
(4) Provide access to medication and medication therapy
management services, where appropriate in accordance with
section 935(c) of the Patient Protection and Affordable Care
Act (Public Law 111-148, 42 U.S.C. § 299b-35(c)).
(5) Promote strong and effective medical management,
including, but not limited to, planning treatment strategies,
monitoring health outcomes and resource use, sharing
information and organizing care to avoid duplication of
services, including the use of electronic medical records. In
sharing information, the protection of the privacy of
individuals and of the individual's individuals' information
shall be priorities. In addition to any and all other Federal
and State provisions for the confidentiality of health care
information, any information-sharing required by a medical
home system shall be subject to written consent of the
patient.
(6) Provide comprehensive care management to patients to
align and assist with treatment strategies, health outcomes,
resource utilization and organization of care and address
determinants of health impeding goals of care.
(7) Emphasize patient and provider accountability.
(8) Prioritize access to the continuum of health care
services in the most appropriate setting and in the most
cost-effective manner.
(9) Establish a baseline for medical home goals and
establish performance measures that indicate a patient has an
established and effective medical home. These goals and
performance measures may include, but need not be limited to,
childhood immunization rates, well-child care utilization
rates, care management for chronic illnesses and emergency
room utilization.
(b) Composition.--The secretary shall appoint the members of
the council, in consultation with the President pro tempore of
the Senate, the Majority Leader of the Senate, the Minority
Leader of the Senate, the Speaker of the House of
Representatives, the Majority Leader of the House of
Representatives and the Minority Leader of the House of
Representatives, who shall consist of the following:
(1) The secretary, or a designee.
(2) A representative of the Pennsylvania Academy of
Family Physicians.
(3) A representative of the Pennsylvania section of the
American Congress of Obstetricians and Gynecologists.
(4) A representative of the Pennsylvania Coalition of
Nurse Practitioners.
(5) A representative of the Pennsylvania Chapter of the
American College of Physicians.
(6) A representative of the Pennsylvania Chapter of the
American Academy of Pediatrics.
(7) A representative of the Pennsylvania Medical
Society.
(8) A representative of the Pennsylvania Pharmacists
Association.
(9) A representative of the Hospital and Health System
Association of Pennsylvania.
(10) A representative of an approved patient-centered
medical home.
(11) A representative of the Mental Health Association
of Pennsylvania.
(12) A representative of the Pennsylvania Association of
Community Health Centers.
(13) A representative of a managed care organization
licensed to do business in this Commonwealth.
(14) A representative of the Pennsylvania Society of
Physician Assistants.
which shall consist of the secretary or a designee and
individuals representing the following interests:
(1) Family physicians.
(2) Obstetricians and gynecologists.
(3) Nurse practitioners.
(4) Internists.
(5) Pediatricians.
(6) Pharmacists.
(7) Hospital and health systems.
(8) Patient-centered medical homes.
(9) Mental health care providers.
(10) Community health centers.
(11) Managed care organizations licensed to do business
in the Commonwealth.
(12) Physician assistants.
(c) Professional organizations representing the professions
indicated in subsection (b) may submit names to the secretary
for the purpose of being appointed to the council.
(c) (d) Terms.--Each member of the council shall serve for a
period of two years. Members may be reappointed by the
secretary.
(d) (e) Meetings.--The department shall establish and
coordinate meetings of the council. The secretary, or the
secretary's designee, shall serve as chairperson of the council.
(e) (f) Expenses.--The members of the council shall not be
paid, but shall be reimbursed for reasonable expenses.
Section 4. Duties of the council.
(a) Organizational model.--The council shall recommend to
the department an organizational model for the patient-centered
medical home system in this Commonwealth, including possible
Medicaid pilot projects. The organizational model shall provide
a strategy to coordinate health care services and provide for
monitoring and data collection on patient-centered medical
homes, for training and education to health care professionals
and families and for transition of children to the adult medical
care system. The organizational model may also include the use
of telemedicine resources and may provide for partnering with
pediatric and family practice residency programs to improve
access to preventive care for children. The organizational
structure shall also address the need to organize and provide
health care to increase accessibility for patients, including
using venues more accessible to patients and having hours of
operation that are conducive to the population served.
(b) Standards.--
(1) The council shall recommend to the department
standards and a process to certify patient-centered medical
homes based on standards developed by a number of
nongovernmental accrediting entities such as the National
Committee for Quality Assurance and Accreditation Association
for Ambulatory Health Care. The certification process and
standards shall provide mechanisms to monitor performance and
to evaluate, promote and improve the quality of health of,
and health care delivered to, patients through a patient-
centered medical home. The standards and process shall also
include a mechanism for other ancillary service providers to
become affiliated with a certified patient-centered medical
home.
(2) The council shall recommend to the department
education and training standards for health care
professionals participating in the patient-centered medical
home system.
(c) Reimbursement methodology.--The council shall recommend
to the department a reimbursement methodology and incentives for
participation in the patient-centered medical home system
sufficient to ensure that providers enter and remain
participating in the system and to promote wellness, prevention,
chronic care management, immunizations, health care management
and the use of electronic health records and other pertinent
concerns. In developing the recommendations, the council shall
consider the feasibility of all of the following:
(1) Reimbursement under the medical assistance program
to promote wellness and prevention and to provide care
coordination and chronic care management.
(2) Increasing to Medicare levels the reimbursement for
certain wellness and prevention services, chronic care
management and immunizations.
(3) Reducing the disparities between reimbursement for
specialty services and primary care services.
(4) Increased funding for efforts to transform medical
practices into patient-centered medical homes, including the
use of electronic health records.
(5) Linking provider reimbursement rates to health care
quality improvement measures established by the department.
(6) Providing reimbursement for medication
reconciliation and medication therapy management service.
(d) Report.--The council shall provide an initial report of
recommendations to the Governor, the Senate and the House of
Representatives by December 31, 2014 2015. Additional reports
shall be provided on December 31 of even-numbered odd-numbered
years so long as the council is in existence.
Section 5. Expiration.
This act shall expire June 30, 2020.
Section 5 6. Effective date.
This act shall take effect immediately.