BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 1542|
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THIRD READING
Bill No: AB 1542
Author: Jones (D), et al
Amended: 8/27/10 in Senate
Vote: 27 - Urgency
WITHOUT REFERENCE TO FILE
SENATE HEALTH COMMITTEE : 6-2, 6/30/10
AYES: Alquist, Cedillo, Leno, Negrete McLeod, Pavley,
Romero
NOES: Strickland, Aanestad
NO VOTE RECORDED: Cox
SENATE BUSINESS, PROF. & ECON. DEV. COMMITTEE : 5-1, 8/9/10
AYES: Negrete McLeod, Corbett, Correa, Florez, Yee
NOES: Aanestad
NO VOTE RECORDED: Wyland, Calderon, Walters
ASSEMBLY FLOOR : 72-0, 5/14/09 - See last page for vote
SUBJECT : Medical homes
SOURCE : California Academy of Family Physicians
DIGEST : This bill establishes the Patient-Centered
Medical Home Act of 2010 to encourage licensed health care
providers and patients to partner in a patient-centered
medical home, as defined, that promotes access to
high-quality, comprehensive care, in accordance with
prescribed requirements.
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ANALYSIS :
Existing law:
1. Establishes the Medical Practice Act to regulate and
govern the practice of physician and surgeons. Provides
that any person who practices medicine must possess a
valid license issued by the Medical Board of California.
2. Specifies that the Department of Public Health shall
license specified primary care clinics and other
specialty clinics. Exempts from licensure any place or
establishment owned or leased and operated as a clinic
or office by one or more licensed health care providers
and used as an office for the practice of their
profession, within the scope of their license,
regardless of the name used publicly to identify the
place or establishment.
3. Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS) and under
which qualified low-income persons receive health care
benefits, as specified.
4. Provides that DHCS shall submit an application to the
federal Centers for Medicare and Medicaid Services for a
waiver or a demonstration project to expand health care
coverage to low-income, uninsured residents, as
specified. Specifies that the waiver or demonstration
project shall include proposals to restructure the
organization and delivery of services to Medi-Cal
enrollees, including proposals for the improved
coordination of care for children with significant
medical needs through the use of medical homes and
specialty centers, as specified.
This bill:
1. Enacts the Patient-Centered Medical Home Act of 2010
which establishes standards for medical homes.
2. States the following legislative intents:
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A. To encourage licensed health care providers and
patients to partner in a patient-centered medical
home that promotes access to high-quality,
comprehensive care, and ensure that Californians have
a medical home.
B. That a California practice or other entity calling
itself a medical home adhere to quality standards
that will do all of the following:
(1) Reduce disparities in health care access,
delivery, and health care outcomes.
(2) Improve quality of health care and lower
health care costs, creating savings to allow more
Californians to have health care coverage and to
provide for the sustainability of the health care
system.
(3) Integrate medical, mental health, and
substance abuse care.
(4) Remove barriers to receiving appropriate
health care.
C. Provides that the state will not provide
enhancement without legislative approval.
3. Defines a medical home, patient-centered medical home
advanced practice primary care, health home and primary
care home as a health care delivery model in which a
patient establishes an ongoing relationship with a
physician or other licensed health care provider acting
within the scope of his/her practice, working in a
physician-directed practice team to provide
comprehensive, accessible, and continuous evidence-based
primary and preventive care, and to coordinate the
patient's health care needs across the health care
system in order to improve quality and health outcomes
in a cost-effective manner.
4. States that a health care delivery model described in
this measure shall stress a team approach to providing
comprehensive health care that fosters a partnership
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among the patient, the licensed health care provider
acting within his/her scope of practice, other health
care professionals, and if appropriate, the patient's
family.
5. Requires a medical home to include all of the following
characteristics:
A. Individual patients have an ongoing relationship
with a physician or other licensed health care
provider acting within his or her scope of practice,
who is trained to provide first contact and
continuous and comprehensive care, or if appropriate,
provide referrals to health care professionals that
provide continuous and comprehensive care.
B. A team of individuals at the practice level
collectively take responsibility for the ongoing
health care of patients. The team is responsible for
providing for all of a patient's health care needs or
taking responsibility for appropriately arranging
health care by other qualified health care
professionals, including making appropriate
referrals.
C. Care is coordinated and integrated across all
elements of the complex health care system and the
patient's community. Care is facilitated, if
available, by registries, information technology,
health information exchanges, and other means to
ensure that patients receive the indicated care when
and where they need and want the care in a culturally
and linguistically appropriate manner.
D. All of the following quality and safety
components.
(1) The medical home advocates for its patients
to support the attainment of optimal,
patient-centered outcomes that are defined by a
care planning process driven by a compassionate,
robust partnership between providers, the patient,
and the patient's family.
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(2) Evidence-based medicine and clinical
decision support tools guide decisionmaking.
(3) Licensed health care providers in the
medical practice who accept accountability for
continuous quality improvement through voluntary
engagement in performance measurement and
improvement.
(4) Patients actively participate in
decisionmaking and feedback is sought to ensure
that the patients' expectations are being met.
(5) Information technology is utilized
appropriately to support optimal patient care,
performance measurement, patient education, and
enhanced communication.
(6) The medical home participates in a voluntary
recognition process conducted by an appropriate
nongovernmental entity to demonstrate that the
practice has the capabilities to provide
patient-centered services consistent with the
medical home model.
(7) Patients and families participate in quality
improvement activities at the practice level.
E. Enhanced access to health care is available
through systems such as open scheduling, expanded
hours, and new options for communication between the
patient, the patient's personal provider, and
practice staff.
6. Provides that this bill shall not be construed to do any
of the following:
A. Permit a medical home to enter into a contractual
relationship that may result in the unlicensed
practice of medicine.
B. Change the scope of practice of physician and
surgeons, nurse practitioners, or other health care
providers.
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C. Affect the ability of a nurse to operate under
standard procedures, as specified.
D. Impede the ability of a practice or entity to call
themselves a medical home if specifically authorized
by statute and the use of the term medical home is
for the purposes of complying with that statute.
E. Prevent or limit the ability of a practice of
entity to participate in activities authorized by the
federal Patient Protection and Affordable Care Act,
as specified. States that nothing in this
subdivision shall be construed to change the scope of
practice of physicians and surgeons, nurse
practitioners, or other health care providers.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 8/30/10)
California Academy of Family Physicians (source)
American College of Physicians
American Congress of Obstetricians and Gynecologists,
District IX
American Nurses Association/California
California Academy of Physician Assistants
California Association of Physician Groups
California Chiropractic Association
California Medical Association
California Psychiatric Association
Latino Coalition for a Healthy California
Osteopathic Physicians and Surgeons of California
ARGUMENTS IN SUPPORT : According to the California
Academy of Family Physicians, the bill's sponsor, and other
supporters such as the Osteopathic Physicians and Surgeons
of California, the California Medical Association, and the
Latino Coalition for a Healthy California, the goal of a
medical home is to provide a patient with a broad spectrum
of coordinated care. With the growing popularity of this
concept among consumers and providers, this bill will
ensure uniform standards of quality and access.
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ASSEMBLY FLOOR :
AYES: Adams, Anderson, Arambula, Beall, Bill Berryhill,
Tom Berryhill, Blakeslee, Block, Blumenfield, Brownley,
Buchanan, Caballero, Charles Calderon, Carter, Chesbro,
Conway, Cook, Coto, Davis, De La Torre, De Leon, DeVore,
Duvall, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuller, Furutani, Galgiani, Gilmore, Hagman, Harkey,
Hayashi, Hernandez, Hill, Huber, Huffman, Jeffries,
Jones, Knight, Krekorian, Lieu, Logue, Bonnie Lowenthal,
Ma, Mendoza, Miller, Monning, Nava, Nestande, Niello,
Nielsen, John A. Perez, V. Manuel Perez, Portantino,
Price, Ruskin, Salas, Silva, Skinner, Solorio, Audra
Strickland, Swanson, Torlakson, Torres, Torrico, Tran,
Villines, Yamada
NO VOTE RECORDED: Ammiano, Fuentes, Gaines, Garrick, Hall,
Saldana, Smyth, Bass
CTW:mw 8/30/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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