BILL NUMBER: AB 2084	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Wood
   (Principal coauthor: Senator Stone)

                        FEBRUARY 17, 2016

   An act to add Section 14132.08 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   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 1.  Section 14132.08 is added to the Welfare and
Institutions Code, to read:
   14132.08.  (a) (1) Comprehensive medication management (CMM)
services are covered under the Medi-Cal program.
   (2) (A) For purposes of this section, "comprehensive medication
management" means the process of care that ensures each beneficiary's
medications, whether they are prescription drugs and biologics,
over-the-counter medication, or nutritional supplements, are
individually assessed to determine that each medication is
appropriate for the beneficiary, effective for the medical condition,
and safe given the comorbidities and other medications being taken,
and all medications are able to be taken by the patient as intended.
   (B) The goals of CMM are to improve quality outcomes for
beneficiaries and to lower overall health care costs by optimizing
appropriate medication use linked directly to achievement of the
clinical goals of therapy.
   (b) CMM services shall be offered to a beneficiary who meets one
or more of the following criteria:
   (1) Is taking three or more prescription drugs or biologics to
treat or prevent one or more chronic medical conditions, or who has
been identified by a treating prescriber as high risk for
medication-related problems and who has one or more chronic diseases.

   (2) Has been discharged from a hospital, rehabilitation facility,
or long-term care setting with one or more chronic medical
conditions, with a need for a plan to enhance care coordination
efforts, including those related to the health home transitional care
services objectives consistent with paragraph (3) of subdivision (b)
of Section 14127.2.
   (3) Has been referred by the beneficiary's treating prescriber as
having a medical condition or gap in care that could benefit from the
provision of CMM services.
   (4) Any other criteria established by the department that is
consistent with the goals of CMM.
   (c) Utilizing the clinical services of a primary care physician or
pharmacist, working in collaboration with other appropriate
providers and in direct communication with the beneficiary, CMM
services that are provided pursuant to this section shall include the
following services:
   (1) Assessment of the beneficiary's health status, including
discussing the beneficiary's personal medication experience and
preferences, and documenting the beneficiary's actual use patterns of
all prescription drugs and biologics, over-the-counter medications,
and nutritional supplements.
   (2) Documentation of the beneficiary's current clinical status and
clinical goals of therapy for each identified chronic condition for
which a medication therapy is indicated, such as current blood
pressure and the prescriber's clinical goals of therapy in a
hypertensive patient.
   (3) Assessment of each medication for appropriateness,
effectiveness, safety, and adherence, with a focus on achievement of
the desired clinical and beneficiary goals.
   (4) Identification of all medication therapy problems.
   (5) Development and implementation, in collaboration with the
beneficiary, of a written medication treatment plan that is designed
to resolve documented medication therapy problems and to prevent
future medication therapy problems, including any additions,
deletions, or adjustments to a medication treatment plan by, or in
collaboration with, the treating prescriber or primary care
physician, that may be needed to achieve optimal therapeutic
outcomes.
   (6) Verbal education and training, information, support services,
and resources designed to enhance the beneficiary's adherence to, and
appropriate use of, medication.
   (7) Follow-up evaluation and monitoring with the beneficiary to
determine the effects of any changes made to a beneficiary's
medication treatment plan, reassess actual outcomes, and recommend or
implement further therapeutic changes necessary to achieve desired
clinical outcomes.
   (d) The typical intervention for a beneficiary receiving CMM
services shall include an average of three to four visits per year
with a CMM primary care physician or pharmacist, as appropriate, to
continually monitor and evaluate medication therapy progress and
problems, and to recommend resolutions or to make changes consistent
with a collaborative practice agreement.
   (e) The department shall evaluate the effectiveness of CMM on
quality of care, patient outcomes, and total program costs, and shall
include a description of any savings generated under the Medi-Cal
program that can be attributed to the coverage of CMM services,
including the effect on emergency room, hospital, and other provider
visit costs. The department may utilize patient and prescriber
surveys to assess the acceptance of, and perceived value added by,
CMM services.