BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 435 (Pan) - Medical home:  health care delivery model
          
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          |Version: April 6, 2015          |Policy Vote: HEALTH 7 - 1       |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: May 4, 2015       |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.



          


          Bill  
          Summary:  SB 435 would require the Secretary of the Health and  
          Human Services Agency to convene a working group to identify  
          appropriate payment methods to align incentives in support of  
          patient centered medical homes.


          Fiscal  
          Impact:  
           Likely one-time costs of $150,000 to $300,000 to provide staff  
            support and technical assistance to the workgroup (General  
            Fund or other fund source).

           Unknown costs for the workgroup to design and compose pilot  
            projects or to establish common patient centered medical home  
            initiatives (General Fund or other fund source).  In addition  
            to requiring the working group to provide recommendations to  







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            the Legislature, the bill gives the working group broad  
            authority to undertake activities that appear more like  
            program development and implementation than traditional study  
            activities undertaken by working groups. The bill does not  
            provide much detail on these authorized activities, so  
            estimating the cost to exercise those authorities is unknown.


          Background:  In concept, a patient centered medical home is a method of  
          providing coordinated health care, using a team of providers, to  
          meet all of the patient's health care needs in a more  
          coordinated, effective, and cost efficient manner. 
          Current law authorizes the Department of Health Care Services to  
          develop a pilot project for a patient centered medical home for  
          certain high-risk Medi-Cal beneficiaries. This pilot would take  
          advantage of authority in the Affordable Care Act that provides  
          enhanced matching funds for patient centered medical home  
          programs. The Department is currently in the process of  
          developing the pilot.




          Proposed Law:  
            SB 435 would require the Secretary of the Health and Human  
          Services Agency to convene a working group to identify  
          appropriate payment methods to align incentives in support of  
          patient centered medical homes.
          Specific provision of the bill would:


           Require the Secretary to convene a working group of public  
            payers, private health insurance carriers, third-party  
            purchasers, and health care providers;
           Require the working group to identify appropriate payment  
            methods to align incentives in support of patient centered  
            medical homes;
           Require the working group to report to the Legislature;
           Authorize the working group to develop consensus strategies  
            for implementing patient centered medical home care models;
           Authorize the working group to create alignment regarding  
            payment, reporting, and infrastructure investments;
           Authorize the working group to design and compose pilot  
            projects;








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           Authorize the working group to utilize public and private  
            purchasing power and enable competing payers to work together  
            to establish patient centered medical home models;
           Authorize the working group to propose participation in  
            federally funded pilot and demonstration models;
           Require the state to use existing resources and federal funds  
            or solicit outside funds to implement the bill.


          Staff  
          Comments:  As noted above, the bill gives the working group very  
          broad authority to undertake what appear to be program  
          development and implementation activities, in addition to  
          developing strategies and reporting to the Legislature. The bill  
          does not provide detail on the scope of those activities.


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