BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 393|
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THIRD READING
Bill No: SB 393
Author: Hernandez (D)
Amended: 5/31/11
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 5/4/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De Le�n, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 6-2, 5/26/11
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Runner
NO VOTE RECORDED: Emmerson
SUBJECT : Medical homes
SOURCE : American Academy of Pediatrics
California Academy of Family Physicians
California Academy of Physician Assistants
California Association for Nurse Practitioners
California Primary Care Association
California Psychiatric Association
Osteopathic Physicians and Surgeons of
California
DIGEST : This bill establishes the Patient-Centered
Medical Home Act of 2011 to encourage licensed health care
providers and patients to partner in a patient-centered
medical home, as defined, promoting access to high-quality,
comprehensive care, in accordance with prescribed
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requirements, and conforming with federal law.
ANALYSIS :
Existing federal law:
1. Defines, under the Patient Protection and Affordable
Care Act (PPACA) (Public Law 111-148), as amended by the
Health Care Education and Reconciliation Act of 2010
(Public Law 111-152), patient-centered medical homes and
authorizes tests of innovative Medicaid and Medicare
service delivery models in federal fiscal years 2010 to
2019, "to reduce program expenditures while preserving
or enhancing patient quality of care." Innovative models
include patient-centered medical homes for high-need
patients and medical homes that address women's unique
health care needs.
2. Makes grants available to states to establish
community-based interdisciplinary teams to support
medical homes and help primary care providers implement
them in federal fiscal years 2011 and 2012.
Existing state law:
1. Defines a "medical home" as a "single provider or
facility that maintains all of an individual's medical
information" for the purposes of the Health Care
Coverage Initiative, a Medi-Cal demonstration project
which provides funding for programs to expand health
care coverage to low income, uninsured residents in
selected counties.
2. Provides for the licensure and regulation of clinics and
health facilities by the Department of Public Health.
3. Provides for the registration, certification, and
licensure of various health care professionals and sets
forth the scope of practice for these professionals.
This bill:
1. Establishes the Patient-Centered Medical Home Act of
2011.
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2. Defines "medical home," "patient-centered medical home,"
"advanced primary home" and "primary care home" to mean
a health care delivery model, as defined by federal
laws.
3. Requires a medical home model meet a variety of
criteria, including:
A. Individual patients have an ongoing relationship
with a physician or other licensed health care
provider acting within his or her scope of practice;
B. A team of individuals at the practice level
collectively takes responsibility for the ongoing
health care of patients;
C. Care is coordinated and integrated across all
elements of the health care system, including mental
health and substance use disorder care, and the
patient's community.
D. Care is facilitated, if available, by registries,
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; and,
E. Quality and safety components are in place which
ensure the following:
(1) The medical home advocates for its patients;
(2) Evidence-based medicine and clinical
decision support tools guide decision-making;
(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
decision-making and feedback is sought to ensure
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that the patients' expectations are being met;
(5) Information technology is utilized
appropriately;
(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; and,
(8) 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.
4. Provides that the bill does not:
A. Permit a medical home to engage in or otherwise
aid and abet in the unlicensed practice of medicine,
either directly or indirectly.
B. Change the scope of practice of physicians and
surgeons, nurse practitioners, or other health care
providers.
C. Affect the ability of a nurse to operate under
standard procedures pursuant to Section 2725 of the
Business and Professions Code.
D. Apply to activities of managed care plans, or
their contracting providers, or county alternative
models of care, or their contracting providers, or
local Coverage Expansion and Enrollment Demonstration
projects, if those activities are part of established
demonstration projects, as specified.
E. Prevent or limit participation in activities
authorized by Sections 2703, 3024, and 3502 of the
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federal Patient Protection and Affordable Care Act
(Public Law 111-148), as amended by the federal
Health Care and Education Reconciliation Act of 2010
(Public Law 111-152), if the participation is
consistent with state law pertaining to scope of
practice.
5. Declares legislative intent to encourage licensed health
care providers and patients to partner in
patient-centered medical homes, and to adhere to quality
standards that will reduce disparities in health care
access, delivery, and health care outcomes, and improve
the quality of health care and lower health care costs.
Background
Medical homes . According to a 2010 brief entitled "Health
Cost Containment and Efficiencies," published by the
National Conference of State Legislatures (NCSL), the
medical home model is designed to address several
shortcomings in the current health care system, especially
uncoordinated care. Poor care coordination is associated
with duplicate procedures, conflicting treatment
recommendations, unnecessary hospitalizations and nursing
home placements, and adverse drug reactions. In addition
to uncoordinated care, medical homes are designed to
address lack of patient access to a primary care doctor,
inadequate physician payment for primary care services, use
of more expensive services when less expensive care would
be as effective, and poor care management for patients with
chronic conditions.
Research has shown that primary care makes significant
contributions to health. Primary care reduces deaths from
heart and lung disease, leads to longer lives, reduces
hospital and emergency room use, and reduces health
disparities. Researchers have linked the United States'
low scores on primary care to higher costs and poorer
health outcomes relative to other developed nations. In
addition, according to the Department of Public Health,
states find that a reliable medical home can magnify the
effect of disease management programs.
According to a 2007 Commonwealth Fund report, "Closing the
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Divide: How Medical Homes Promote Equity in Health Care,"
when adults have health insurance coverage and a medical
home, racial and ethnic disparities in access and quality
tend to disappear. The analysis, based on a Commonwealth
Fund survey of more than 2,830 adults nationwide, reveals
that linking minority patients to a medical home can help
them better manage chronic conditions and obtain critical
preventive care.
In a 2008 report to the United States Congress, the federal
Medicare Payment Advisory Commission recommended that
Congress establish a budget-neutral payment increase for
primary care services furnished by primary-care-focused
practitioners (defined as those whose specialty designation
is defined as primary care or whose pattern of claims meets
a minimum threshold of furnishing primary care services).
The Commission also recommended that Congress initiate a
Medicare medical home pilot project, with stringent
specified criteria and a physician pay-for-performance
program.
Medical home model in other states . NCSL reports that, as
of July 2010, at least 29 states had enacted medical home
legislation and 22 had one or more public, private or
public-private medical home pilot programs.
Many states have adopted medical home legislation and
programs, mostly for Medicaid and Children's Health
Insurance Program (CHIP) enrollees. Some states, such as
Iowa, Oregon, Pennsylvania and Vermont, also allow or
encourage private sector participation. Community Care of
North Carolina, the state's Medicaid program, is a working
example of a patient centered medical home. The goals of
the program are to improve the care of the Medicaid
population, control costs, develop community-based networks
to manage care of populations in partnership with the
state, and fully develop the medical home model. The
program has demonstrated excellent quality and cost
outcomes through disease management, evidence-based
clinical practice, and an emphasis on a physician-led team
approach. Two evaluations of this program indicate it
saved the State of North Carolina $195 to $215 million in
2003 and between $230 and $260 million in 2004 when
compared to historical fee-for-service.
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In the private sector, IBM also implemented a
"patient-centric medical home" which is similar to the
medical home defined in this bill. According to the
company, as a result, its injury and illness rates are
lower than the rest of the industry. IBM employees also
had nine to twenty-five percent fewer emergency room visits
and a sixteen percent reduction in medical and
pharmaceutical costs. These savings also led to lower
premiums and $100 million savings annually, including
through increased productivity.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
Potential increased costs to cost pressure
likely in the millions of General/
Medi-Cal, Healthy Families dollars commencing January
1, 2012 Federal/
CalPERS, and other public-
Special
funded health care coverage
SUPPORT : (Verified 5/27/11)
American Academy of Pediatrics (co-source)
California Academy of Family Physicians (co-source)
California Academy of Physician Assistants (co-source)
California Association for Nurse Practitioners (co-source)
California Primary Care Association (co-source)
California Psychiatric Association (co-source)
Osteopathic Physicians and Surgeons of California
(co-source)
American College of Physicians, California Chapter
American Congress of Obstetricians and Gynecologists,
District IX
American Nurses Association of California
California Association of Physician Groups
California Mental Health Directors Association
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California Pharmacists Association
California Society of Health-System Pharmacists
Children Now
Planned Parenthood Affiliates of California
Six Rivers Planned Parenthood
Southern California Society of Health-System Pharmacists
ARGUMENTS IN SUPPORT : The California Academy of Family
Physicians, one of the bill's sponsors, states that the
goal of the medical home model is to utilize a team of
professionals to provide to a patient and coordinate a
broad spectrum of coordinated care and that as this concept
grows in popularity among consumers and providers, this
bill will ensure uniform standards of quality and access.
Supporters of this bill add that this bill will ensure
inclusivity of all licensed primary care providers in the
medical home model.
CTW:mw 5/31/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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