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


Bill Title: Medical homes.

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
BILL NUMBER: AB 1542	AMENDED
	BILL TEXT

	AMENDED IN SENATE  AUGUST 27, 2010
	AMENDED IN SENATE  AUGUST 11, 2010
	AMENDED IN SENATE  AUGUST 3, 2010
	AMENDED IN SENATE  AUGUST 2, 2010
	AMENDED IN SENATE  JUNE 24, 2010
	AMENDED IN SENATE  APRIL 27, 2010
	AMENDED IN SENATE  JULY 1, 2009
	AMENDED IN ASSEMBLY  MAY 6, 2009

INTRODUCED BY   Assembly Member Jones
    (   Principal coauthor:   Senator 
 Alquist   ) 

                        MARCH 4, 2009

   An act to add Chapter  3.34 (commencing with Section
1596.55) to Division 2   3.5 (commencing with Section
24300) to Division 20  of the Health and Safety Code, relating
to medical homes, and declaring the urgency thereof, to take effect
immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1542, as amended, Jones. Medical homes.
   Existing law provides for the licensure and regulation of clinics
and health facilities by the State Department of Public Health.
Existing law also provides for the registration, certification, and
licensure of various health care professionals and sets forth the
scope of practice for these professionals.
   This bill would establish the Patient-Centered Medical Home Act of
2010 to encourage licensed health care providers and patients to
partner in a patient-centered medical home, as defined, that promotes
access to high-quality, comprehensive care, in accordance with
prescribed requirements.
   This bill would declare that it is to take effect immediately as
an urgency statute.
   Vote: 2/3. Appropriation: no. Fiscal committee: no. State-mandated
local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
   
  SECTION 1.    Chapter 3.34 (commencing with
Section 1596.55) is added to Division 2 of the Health and Safety
Code, to read:
      CHAPTER 3.34.  PATIENT-CENTERED MEDICAL HOME ACT OF 2010


   1596.55.   
  SECTION 1.    Chapter 3.5 (commencing with Section 24300)
is added to Division 20 of the Health and Safety Code, to read: 

      CHAPTER 3.5.   PATIENT-CENTERED MEDICAL HOME ACT OF 2010


    24300.  (a) This chapter shall be known, and may be
cited, as the Patient-Centered Medical Home Act of 2010.
   (b) It is the intent of the Legislature to encourage licensed
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 the intent of the Legislature that a medical home adhere
to 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) Integrate medical, mental health, and substance use disorder
care.
   (4) Remove barriers to receiving appropriate health care.
   (d) It is further the intent of the Legislature that payors take
into account the increased services and overhead associated with this
practice model, and the potential savings from better managing
chronic diseases and conditions, including, but not limited to, all
of the following:
   (1) Coordination of care within the practice and between
consultants, ancillary providers, and community resources.
   (2) Adoption and use of health information technology for quality
improvement.
   (3) Increased patient access through advanced appointment systems,
electronic patient portals, secure electronic mail, remote access
monitoring systems, and telephone consultations.
   (4) Risk adjustments based on the case mix, type and severity of
patient illness, and patient age for the patient population.
   (5) Provision for monetary reimbursement for added services among
the various payment systems, including fee-for-service, value-added
global, shared savings, and capitated payments. 
   (e) It is further the intent of the Legislature that the state
shall not provide enhanced reimbursement for the establishment of a
medical home model pursuant to this chapter until an analysis of the
costs and benefits has been performed and approval has been granted
by the Legislature. 
    1596.56.   24301.   (a) "Medical home,"
"patient-centered medical home," "advanced practice primary care,"
"health home," "person-centered health care home," and "primary care
home" all mean a health care delivery model in which a patient
establishes an ongoing relationship with a physician or other
licensed health care provider acting within the scope of his or her
practice, working in a physician-directed practice team to provide
comprehensive, accessible, and continuous evidence-based primary and
preventative care, and to coordinate the patient's health care needs
across the health care system in order to improve quality and health
outcomes in a cost-effective manner.
   (b) A health care delivery model described in this section shall
stress a team approach to providing comprehensive health care that
fosters a partnership among the patient, the licensed health care
provider acting within his or her scope of practice, other health
care professionals, and, if appropriate, the patient's family.
    1596.57.   24302.   Unless otherwise
provided by statute, a medical home shall include all of the
following characteristics:
   (a) Individual patients have an ongoing relationship with a
physician or other licensed health care provider acting within his or
her scope of practice, who is trained to provide first contact and
continuous and comprehensive care, or if appropriate, provide
referrals to health care professionals that provide continuous and
comprehensive care.
   (b) A team of individuals at the practice level collectively take
responsibility for the ongoing health care of patients. The team 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, including making
appropriate referrals.
   (c) Care is coordinated and integrated across all elements of the
complex health care system, including mental health and substance use
disorder care, and the patient's community. Care is facilitated, if
available, 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.
   (d) All of the following quality and safety components:
   (1) The medical home advocates for its 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) Licensed health care providers in the medical practice who
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) The medical home participates 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.
   (e) 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.
    1596.58.   24303.   Nothing in this
chapter shall be construed to do any of the following:
   (a) Permit a medical home to engage in or otherwise aid and abet
in the unlicensed practice of medicine, either directly or
indirectly.
   (b) Change the scope of practice of physicians and surgeons, nurse
practitioners, or other health care providers.
   (c) Affect the ability of a nurse to operate under standard
procedures pursuant to Section 2725 of the Business and Professions
Code.
   (d) Apply to activities of managed care plans, or their
contracting providers, or county alternative models of care, or their
contracting providers,  or local Coverage Expansion and
Enrollment Demonstration projects,  if those activities are part
of demonstration projects developed pursuant to Section 14180 of the
Welfare and Institutions Code  or any successor projects to the
health care coverage initiative programs developed pursuant to Part
3.5 (commencing with Section 15900) of the Welfare and Institutions
Code  .
   (e) Prevent or limit participation in activities authorized by
Sections 2703, 3024, and 3502 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148), as amended by the federal
Health Care and Education Reconciliation Act of 2010 (Public Law
111-152), if the participation is consistent with state law
pertaining to scope of practice.
  SEC. 2.  This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
   In order to make the necessary statutory changes to avoid
participant confusion about medical homes as defined by this act, the
demonstration projects developed pursuant to Section 14180 of the
Welfare and Institutions Code, and participation in Section 2703, of
the federal Patient Protection and Affordable Care Act (Public Law
111-148), as amended by the federal Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152), it is necessary that
this act take effect immediately.                    
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