BILL ANALYSIS Ó
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ASSEMBLY THIRD READING
AB 1208 (Pan)
As Amended April 23, 2013
Majority vote
HEALTH 17-2
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|Ayes:|Pan, Logue, Ammiano, |
| |Atkins, Bonilla, Bonta, |
| |Chesbro, Gomez, Roger |
| |Hernández, Bocanegra, |
| |Maienschein, Mitchell, |
| |Nazarian, Nestande, V. |
| |Manuel Pérez, Wieckowski, |
| |Wilk |
| | |
|-----+--------------------------|
|Nays:|Mansoor, Wagner |
| | |
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SUMMARY : Establishes the Patient Centered Medical Home (PCMH)
Act of 2013 which defines medical homes and specifies its
characteristics. Specifically, this bill :
1) Defines medical home and PCMH to mean a health care
delivery model in which a patient establishes an ongoing
relationship with a personal primary care physician or
other licensed health care provider acting within the scope
of his or her practice.
2) Provides that the personal provider works 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.
3) Requires a medical home to 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
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patient's family.
4) Requires a PCMH to include all of the following
characteristics:
a) Individual patients shall have an ongoing relationship
with a physician and surgeon 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 provider-led team of individuals at the practice level
shall take collective responsibility for the ongoing health
care of patients, including appropriately arranging health
care by other qualified health care professionals and
making appropriate referrals.
c) Care shall be 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 shall be facilitated by health
information technology, such as electronic medical records,
electronic patient portals, health information exchanges,
and other means to ensure that patients receive the
indicated care when and where they need and want this care
in a culturally and linguistically appropriate manner.
d) The medical home payment structure shall be designed to
reward the provision of the right care in the right
setting, and discourage the delivery of too much or too
little care. The payment structure shall encourage
appropriate management of complex medical cases, increased
access to care, the measurement of patient outcomes,
continuous improvement of care quality, and comprehensive
integration and coordination across all stages and settings
of a patient's care.
e) Patients shall be provided with enhanced access to
health care that meets the requirements of a nationally
recognized, independent, medical home accreditation agency.
f) All of the following quality and safety components shall
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be incorporated into the PCMH:
i) Advocacy for 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 or representative;
ii)Evidence-based medicine and clinical decision support
tools guide decisionmaking;
iii)The licensed health care providers in the practice
accept accountability for continuous quality improvement
through voluntary engagement in performance measurement
and improvement;
iv)Active patient participation in decisionmaking.
Feedback is sought to ensure that the patient's
expectations are being met;
v) Information technology is utilized appropriately to
support optimal patient care, performance measurement,
patient education, and enhanced communication; and,
vi)Patients and families or representative participate in
quality improvement activities at the practice level.
5) Prohibits construing this bill to do any of the
following:
a) Permit a PCMH 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, as specified;
d) Require adherence to the Low Income Health Program
(LIHP) development, as specified, including the program's
provider network and service delivery system, or to
activities conducted as part of a demonstration project, as
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specified; or,
e) Prevent or limit participation in authorized federal
activities, as specified, if the participation is
consistent with state law pertaining to scope of practice.
EXISTING LAW :
1)Defines PCMH under the federal Affordable Care Act (ACA) and
authorizes tests of innovative Medicaid (Medi-Cal in
California) and Medicare service delivery models in federal
fiscal years 2010 to 2019, to reduce program expenditures
while preserving or enhancing patient quality of care.
Provides that innovative models include PCMHs for high-need
patients and medical homes that address women's unique health
care needs.
2)Makes grants under the ACA available to states to establish
community-based interdisciplinary teams to support medical
homes and help primary care providers implement them in
federal fiscal years 2011 and 2012.
3)Authorizes the waiving of specified Medicaid requirements for
demonstration projects, for care delivered through primary
care case-management systems, or for the provision of home- or
community-based services.
4)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income persons receive health care benefits.
FISCAL EFFECT : None
COMMENTS : According to the author, by adding a PCMH definition
this bill ensures uniform standards of quality and access, and
encourage health care providers to work as a team to provide
patient-centered care. Additionally, adding a PCMH definition
sends an important signal to health care providers and patients
that California supports: a) care that is patient-centered,
cost-efficient, continuous, focused on prevention, and based on
sound, evidence-based medicine rather than episodic,
illness-oriented "siloed" care; and, b) a health care team
(doctors, nurses, physician assistants, medical assistants,
mental health providers, community health workers, social
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workers, etc.) working in partnership with one another, their
patients and their patients' families to coordinate care,
navigate the complex and often confusing health care system and
ensure that patients receive the right care at the right time.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097
FN: 0000268