BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session SB 435 (Pan) - Medical home: health care delivery model ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: April 6, 2015 |Policy Vote: HEALTH 7 - 1 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: May 4, 2015 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- 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 SB 435 (Pan) Page 1 of ? 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; SB 435 (Pan) Page 2 of ? 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. -- END --