Bill Text: CA AB1542 | 2009-2010 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Medical homes.

Spectrum: Strong Partisan Bill (Democrat 13-1)

Status: (Engrossed - Dead) 2010-09-01 - Urgency clause refused adoption. (Ayes 50. Noes 17. Page 6984.) Motion to reconsider made by Assembly Member Jones. [AB1542 Detail]

Download: California-2009-AB1542-Amended.html

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BILL NUMBER: AB 1542	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 1, 2009
	AMENDED IN ASSEMBLY  MAY 6, 2009

INTRODUCED BY   Committee on Health (Jones (Chair), Adams, Ammiano,
Block, Carter, De La Torre, De Leon, Hayashi, Hernandez, Bonnie
Lowenthal, Nava, V. Manuel Perez, and Salas)

                        MARCH 4, 2009

   An act to add Part 3.6 (commencing with Section 15950) to Division
9 of the Welfare and Institutions Code, relating to health care
services.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1542, as amended, Committee on Health. Medical homes.
   Existing law imposes various functions and duties on the State
Department of Health Care Services with respect to the administration
and oversight of various health programs and facilities, including
the Medi-Cal program.
   This bill would establish the Patient-Centered Medical Home
 Act of 2009   Pilot Project  to encourage
health care providers and patients to partner in a patient-centered
medical home, as defined, that promotes access to high-quality,
comprehensive care.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Part 3.6 (commencing with Section 15950) is added to
Division 9 of the Welfare and Institutions Code, to read:

      PART 3.6.  Patient-Centered Medical Home  Act of 2009
  Pilot Project 


   15950.  (a)  This part shall be known, and may be cited,
as the   There is hereby established the 
Patient-Centered Medical Home  Act of 2009  
Pilot Project  .
   (b) It is the intent of the Legislature to encourage health care
providers and patients to partner in a patient-centered medical home
that promotes access to high-quality, comprehensive care and
ultimately to ensure that all Californians have a medical home.
   (c) It is further the intent of the  legislature that any
  Legislature that a  California provider,
practice, or institution calling itself a medical home adhere to
nationally recognized quality standards that will do all of the
following:
   (1) Reduce disparities in health care access, delivery, and health
care outcomes.
   (2) Improve quality of health care and lower health care costs,
thereby creating savings to allow more Californians to have health
care coverage and to provide for the sustainability of the health
care system.
   (3) Meet the National Committee for Quality Assurance (NCQA)
definition and characteristics of a medical home.
   15951.  As used in this part, the following terms have the
following meanings:
   (a) "Medical home" means a team approach to providing health care
that fosters a partnership among the patient, the personal provider
 ,  and other health care professionals, and  ,
 where appropriate, the patient's family, utilizes the
partnership to access all medical and nonmedical health-related
services needed by the patient and the patient's family to achieve
maximum health potential, maintains a comprehensive record of all
health-related services to promote continuity of care, and has all of
the characteristics that qualify it as a medical home.
   (b) "National Committee for Quality Assurance" means the
nationally recognized, independent nonprofit organization that
measures the quality and performance of health care and health care
plans in the United States, provides accreditation, certification,
and recognition of programs for health care plans and programs, and
is recognized in California as an accrediting organization for
commercial and Medi-Cal-managed care organizations.
   (c) "Personal provider" means the patient's first point of contact
in the health care system with a primary care provider who
identifies the patient's health needs, and, working with a team of
health care professionals, provides for and coordinates appropriate
care to address the health needs identified.
   (d) "Primary care" means health care that emphasizes providing for
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.
   15952.  A "medical home," for the purposes of this part, meets the
standards set forth by the National Committee for Quality Assurance,
and includes all of the following characteristics:
   (a) An ongoing personal provider for each patient trained to
provide first contact, continuous, and comprehensive care.
   (b) The personal provider leads a team of individuals at the
practice level who collectively take responsibility for the ongoing
health care of patients.
   (c) The personal provider is responsible for providing for all of
a patient's health care needs or taking responsibility for
appropriately arranging health care by other qualified health care
professionals. This responsibility includes health care at all stages
of life including provision of acute care, chronic care, preventive
services, and end-of-life care.
   (d) Care is coordinated and integrated across all elements of the
complex health care system and the patient's community. Care is
facilitated by registries, information technology, health information
exchanges, and other means to ensure that patients receive the
indicated care when and where they need and want the care in a
culturally and linguistically appropriate manner.
   (e) All of the following quality and safety components:
   (1) Provider-directed medical practices advocate for their
patients to support the attainment of optimal, patient-centered
outcomes that are defined by a care planning process driven by a
compassionate, robust partnership between providers, the patient, and
the patient's family.
   (2) Evidence-based medicine and clinical decision support tools
guide decisionmaking.
   (3) Providers in the medical practice accept accountability for
continuous quality improvement through voluntary engagement in
performance measurement and improvement.
   (4)  Patients actively participate in decisionmaking and feedback
is sought to ensure that the patients' expectations are being met.
   (5) Information technology is utilized appropriately to support
optimal patient care, performance measurement, patient education, and
enhanced communication.
   (6) Practices participate in a voluntary recognition process
conducted by an appropriate nongovernmental entity to demonstrate
that the practice has the capabilities to provide patient-centered
services consistent with the medical home model.
   (7) Patients and families participate in quality improvement
activities at the practice level.
   (f) Enhanced access to health care is available through systems
such as open scheduling, expanded hours, and new options for
communication between the patient, the patient's personal provider,
and practice staff.
   (g) The payment system appropriately recognizes the added value
provided to patients who have a patient-centered medical home. The
payment structure framework of the medical home does all of the
following:
   (1) Reflects the value of provider and nonprovider staff and
patient-centered care management work that is in addition to the
face-to-face visit.
   (2) Pays for services associated with coordination of health care
both within a given practice and between consultants, ancillary
providers, and community resources.
   (3) Supports adoption and use of health information technology for
quality improvement.
   (4) Supports provision of enhanced communication access such as
secure electronic mail and telephone consultation.
   (5) Recognizes the value of provider work associated with remote
monitoring of clinical data using technology.
   (6) Allows for separate fee-for-service payments for face-to-face
visits. Payments for health care management services that are in
addition to the face-to-face  visit   visits
 do not result in a reduction in the payments for face-to-face
visits.
   (7) Recognizes case mix differences in the patient population
being treated within the practice.
   (8) Allows providers to share in savings from reduced
hospitalizations associated with provider-guided health care
management in the office setting.
   (9) Allows for additional payments for achieving measurable and
continuous quality improvements.