AB 2084, as introduced, Wood. Medi-Cal: comprehensive medication management.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, which includes outpatient prescription drugs, subject to utilization controls and the Medi-Cal list of contract drugs.
This bill would provide that comprehensive medication management (CMM) services, as defined, are a covered benefit under the Medi-Cal program, and would require those services to include, among other things, the development and implementation of a written medication treatment plan that is designed to resolve documented medication therapy problems and to prevent future medication therapy problems. The bill would require the department to evaluate the effectiveness of CMM on quality of care, patient outcomes, and total program costs, as specified.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14132.08 is added to the Welfare and
2Institutions Code, to read:
(a) (1) Comprehensive medication management
4(CMM) services are covered under the Medi-Cal program.
5(2) (A) For purposes of this section, “comprehensive medication
6management” means the process of care that ensures each
7beneficiary’s medications, whether they are prescription drugs and
8biologics, over-the-counter medication, or nutritional supplements,
9are individually assessed to determine that each medication is
10appropriate for the beneficiary, effective for the medical condition,
11and safe given the comorbidities and other medications being
12taken, and all medications are able to be taken by the patient as
13intended.
14(B) The goals of CMM
are to improve quality outcomes for
15beneficiaries and to lower overall health care costs by optimizing
16appropriate medication use linked directly to achievement of the
17clinical goals of therapy.
18(b) CMM services shall be offered to a beneficiary who meets
19one or more of the following criteria:
20(1) Is taking three or more prescription drugs or biologics to
21treat or prevent one or more chronic medical conditions, or who
22has been identified by a treating prescriber as high risk for
23medication-related problems and who has one or more chronic
24diseases.
25(2) Has been discharged from a hospital, rehabilitation facility,
26or long-term care setting with one or more chronic medical
27conditions, with a need for a plan to enhance care coordination
28efforts, including those related to the health home transitional care
29services
objectives consistent with paragraph (3) of subdivision
30(b) of Section 14127.2.
31(3) Has been referred by the beneficiary’s treating prescriber
32as having a medical condition or gap in care that could benefit
33from the provision of CMM services.
34(4) Any other criteria established by the department that is
35consistent with the goals of CMM.
P3 1(c) Utilizing the clinical services of a primary care physician or
2pharmacist, working in collaboration with other appropriate
3providers and in direct communication with the beneficiary, CMM
4services that are provided pursuant to this section shall include the
5following services:
6(1) Assessment of the beneficiary’s health status, including
7discussing the beneficiary’s personal medication experience and
8preferences, and
documenting the beneficiary’s actual use patterns
9of all prescription drugs and biologics, over-the-counter
10medications, and nutritional supplements.
11(2) Documentation of the beneficiary’s current clinical status
12and clinical goals of therapy for each identified chronic condition
13for which a medication therapy is indicated, such as current blood
14pressure and the prescriber’s clinical goals of therapy in a
15hypertensive patient.
16(3) Assessment of each medication for appropriateness,
17effectiveness, safety, and adherence, with a focus on achievement
18of the desired clinical and beneficiary goals.
19(4) Identification of all medication therapy problems.
20(5) Development and implementation, in collaboration with the
21beneficiary, of a written medication treatment
plan that is designed
22to resolve documented medication therapy problems and to prevent
23future medication therapy problems, including any additions,
24deletions, or adjustments to a medication treatment plan by, or in
25collaboration with, the treating prescriber or primary care
26physician, that may be needed to achieve optimal therapeutic
27outcomes.
28(6) Verbal education and training, information, support services,
29and resources designed to enhance the beneficiary’s adherence to,
30and appropriate use of, medication.
31(7) Follow-up evaluation and monitoring with the beneficiary
32to determine the effects of any changes made to a beneficiary’s
33medication treatment plan, reassess actual outcomes, and
34recommend or implement further therapeutic changes necessary
35to achieve desired clinical outcomes.
36(d) The typical intervention for
a beneficiary receiving CMM
37services shall include an average of three to four visits per year
38with a CMM primary care physician or pharmacist, as appropriate,
39to continually monitor and evaluate medication therapy progress
P4 1and problems, and to recommend resolutions or to make changes
2consistent with a collaborative practice agreement.
3(e) The department shall evaluate the effectiveness of CMM on
4quality of care, patient outcomes, and total program costs, and
5shall include a description of any savings generated under the
6Medi-Cal program that can be attributed to the coverage of CMM
7services, including the effect on emergency room, hospital, and
8other provider visit costs. The department may utilize patient and
9prescriber surveys to assess the acceptance of, and perceived value
10added by, CMM services.
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