Amended in Senate April 6, 2015

Senate BillNo. 435


Introduced by Senator Pan

February 25, 2015


An act to add Chapter 3.5 (commencing with Section 24300) to Division 20 of the Health and Safety Code, relating to health care.

LEGISLATIVE COUNSEL’S DIGEST

SB 435, as amended, Pan. Medical home: health care delivery model.

Existing law requires the Office of Statewide Health Planning and Development to perform various functions and duties with respect to health policy and planning and health professions development. Existing law states the Legislature’s finding that there is a need to improve the effectiveness of health care delivery systems. Existing law generally defines a medical home as a single provider, facility, or team that coordinatesbegin delete andend deletebegin insert anend insert individual’s health carebegin delete serevices.end deletebegin insert services.end insert

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This bill would declare the intent of the Legislature to enact legislation to establish the “patient centered medical home” health care delivery model.

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This bill would require the Secretary of California Health and Human Services to convene a working group of public payers, private health insurance carriers, third-party purchasers, and health care providers to identify appropriate payment methods to align incentives in support of patient centered medical homes. The bill would prescribe the powers and duties of the working group, including consulting with, and providing recommendations to, the Legislature and relevant state agencies on matters relating to the implementation of the patient centered medical home care model. The bill would be implemented using state and federal funds, grants, donations, and other financial support, as prescribed.

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This bill would make legislative findings and declarations regarding the intent of the Legislature to exempt and immunize activities undertaken in connection with patient centered medical homes from state and federal antitrust laws, as specified.

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Vote: majority. Appropriation: no. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1begin insert

begin insertSECTION 1.end insert  

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begin insertThe Legislature finds and declares as follows:end insert

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2(a) It is the intent of the Legislature in enacting this act to
3provide for collaboration among public payers, private health
4insurance carriers, third-party purchasers, and health care
5providers, as necessary to identify consistent appropriate payment
6methods to support chronic care management in, and to align
7incentives in support of, patient centered medical homes.

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8(b) It is the intent of the Legislature to exempt from state
9antitrust laws and to provide immunity from federal antitrust laws,
10pursuant to the state action doctrine for, any activities undertaken
11pursuant to this act that otherwise might be constrained by those
12laws. It is not the intent of the Legislature to authorize any person
13or entity to engage in or conspire to engage in any activity that
14would constitute a per se violation of state or federal antitrust
15laws, including, but not limited to, an agreement among competing
16health care providers or health insurance carriers as to the price
17or specific level of payment for a health care service.

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18(c) It is the intent of the Legislature that the state shall articulate
19a clear and affirmative policy describing its intent to displace
20competition with respect to the implementation of this act, and
21shall actively supervise anticompetitive conduct and its results
22with ongoing oversight.

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23

begin deleteSECTION 1.end delete
24begin insertSEC. 2.end insert  

Chapter 3.5 (commencing with Section 24300) is added
25to Division 20 of the Health and Safety Code, to read:

 

P3    1Chapter  3.5. Patient Centered Medical Home Health
2Care Delivery Model
3

 

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4

24300.  

It is the intent of the Legislature to enact legislation to
5establish the “patient centered medical home” health care delivery
6model.

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7

begin insert24300.end insert  

The Secretary of California Health and Human Services
8shall convene a working group of public payers, private health
9insurance carriers, third-party purchasers, and health care
10providers to identify appropriate payment methods to align
11incentives in support of patient centered medical homes.

end insert
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12

begin insert24301.end insert  

(a) The working group convened pursuant to this
13chapter shall consult with, and provide recommendations to, the
14Legislature and relevant state agencies on all matters relating to
15the implementation of a patient centered medical home care model.

16(b) The working group shall have the authority to do all of the
17following:

18(1) Develop consensus on strategies for implementing the patient
19centered medical home care model and service delivery change
20at the practice, community, and health care system level.

21(2) Create alignment regarding payment, reporting, and
22infrastructure investments.

23(3) Design and compose pilot projects, including multipayer
24pilot projects.

25(4) Utilize public and private purchasing power and enable
26competing payers to work collaboratively to establish common
27patient centered medical home initiatives.

28(5) Propose participation in relevant federally funded pilot and
29demonstration projects.

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30

begin insert24302.end insert  

The state shall use existing state resources and available
31federal funds to implement this chapter. If state or federal funds
32are not available, the secretary may apply for and accept grants,
33or receive donations and other financial support from public or
34private sources, for purposes of this chapter.

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