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  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

                        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.   An act to add Chapter 3.34 (commencing
with Section 1596.55) to Division 2 of the Health and Safety Code,
relating to medical homes. 


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1542, as amended, Jones. 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.  
   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
 Pilot Project   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  .
   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.    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.  (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 California practice
or other entity calling itself 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 abuse care.
   (4) Remove barriers to receiving appropriate health care.
   (d) It is further the intent of the Legislature that payors
recognize the added value of a medical home by providing additional
payment for the increased services and overhead associated with this
practice model, 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, remove 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.
   1596.56.  As used in this chapter, the following terms have the
following meanings:
   (a) (1) "Medical home," "patient-centered medical home," "advanced
practice primary care," "health 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-led 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.
   (2) A health care delivery model specified in paragraph (1)
stresses 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.
   (b) "Practice" means a clinic that is exempt from licensure
pursuant to subdivision (a) of Section 1206 that is owned and
operated by persons authorized by law to provide comprehensive
medical services to patients or a primary care clinic that is
licensed under subdivision (a) of Section 1204.
   (c) "Other entity" means a hospital-affiliated primary care clinic
or a clinic that is owned and operated by a county or the University
of California.
   1596.57.  Notwithstanding any other provision of law, no practice
or other entity shall represent itself as a medical home unless it
includes 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. This responsibility
includes health care at all stages of life including provision of
acute care, chronic care, preventive services, and end-of-life care.
   (c) Care is coordinated and integrated across all elements of the
complex health care system 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.  Nothing in this chapter shall be construed to do any of
the following:
   (a) Permit a medical home to enter into a contractual relationship
that may result in the unlicensed practice of medicine.
   (b) Change the scope of practice of physician 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.  
  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 Pilot Project


   15950.  (a) There is hereby established the Patient-Centered
Medical Home 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 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 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 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.