Amended in Senate June 2, 2015

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 coordinates an individual’s health care services.

This bill would require the Secretary of California Health and Human Services to convene a working group of public payers, private health insurance carriers,begin delete third-partyend deletebegin insert 3rd-partyend insert 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 wouldbegin delete be implemented using state and federal funds, grants, donations, and other financial support, as prescribed.end deletebegin insert require the secretary to convene the working groupend insertbegin insert only after making a determination that sufficient nonstate funds have been received to pay for all costs of implementing the bill.end insert

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.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

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

P2    1

SECTION 1.  

The Legislature finds and declares as follows:

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 providers,
5as necessary to identify consistent appropriate payment methods
6to support chronic care management in, and to align incentives in
7support of, patient centered medical homes.

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 laws,
15including, but not limited to, an agreement among competing health
16care providers or health insurance carriers as to the price or specific
17level of payment for a health care service.

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.

23

SEC. 2.  

Chapter 3.5 (commencing with Section 24300) is added
24to Division 20 of the Health and Safety Code, to read:

 

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

 

4

24300.  

The Secretary of California Health and Human Services
5shall convene a working group of public payers, private health
6insurance carriers, third-party purchasers, and health care providers
7to identify appropriate payment methods to align incentives in
8support of patient centered medical homes.

9

24301.  

(a) The working group convened pursuant to this
10chapter shall consult with, and provide recommendations to, the
11Legislature and relevant state agencies on all matters relating to
12the implementation of a patient centered medical home care model.

13(b) The working group shall have the authority to do all of the
14following:

15(1) Develop consensus on strategies for implementing the patient
16centered medical home care model and service delivery change at
17the practice, community, and health care system level.

18(2)  begin deleteCreate end delete begin insertIdentify ways to create end insertalignment regarding payment,
19reporting, and infrastructure investments.

begin delete

20(3) Design and compose pilot projects, including multipayer
21pilot projects.

end delete
begin delete

22(4) Utilize

end delete

23begin insert(3)end insertbegin insertend insertbegin insertIdentify ways to utilizeend insert public and private purchasing power
24andbegin insert ways toend insert enable competing payers to work collaboratively to
25establish common patient centered medical home initiatives.

begin delete

26(5)

end delete

27begin insert(4)end insert Propose participation in relevant federally funded pilot and
28demonstration projects.

begin delete
29

24302.  

The state shall use existing state resources and available
30federal funds to implement this chapter. If state or federal funds
31are not available, the secretary may apply for and accept grants,
32or receive donations and other financial support from public or
33private sources, for purposes of this chapter.

end delete
begin insert
34

begin insert24302.end insert  

The secretary shall convene the working group only
35after he or she makes a determination that sufficient nonstate funds
36have been received to pay for all costs of implementing this
37chapter.

end insert


O

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