BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 393|
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UNFINISHED BUSINESS
Bill No: SB 393
Author: Hernandez (D)
Amended: 8/24/12
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
SENATE FLOOR : 30-7, 6/2/11
AYES: Alquist, Anderson, Blakeslee, Calderon, Corbett,
Correa, De Le�n, DeSaulnier, Emmerson, Evans, Hancock,
Hernandez, Kehoe, Leno, Lieu, Liu, Lowenthal, Negrete
McLeod, Padilla, Pavley, Price, Rubio, Simitian,
Steinberg, Strickland, Vargas, Wolk, Wright, Wyland, Yee
NOES: Dutton, Fuller, Gaines, Harman, Huff, La Malfa,
Walters
NO VOTE RECORDED: Berryhill, Cannella, Runner
ASSEMBLY FLOOR : Not available
SUBJECT : Patient-centered medical homes
SOURCE : American Academy of Pediatrics
California Academy of Family Physicians
California Academy of Physician Assistants
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California Primary Care Association
California Psychiatric Association
Osteopathic Physicians and Surgeons of
California
DIGEST : This bill establishes the Patient-Centered
Medical Home Act of
2012 and defines patient-centered medical home. This bill
provides that a physician-directed practice team shall not
be construed to prohibit activities conducted pursuant to
specified provisions of law regarding scope of practice.
This bill specifies that its provisions do not alter the
scope of practice of any health care provider.
Assembly Amendments prohibit this bill from being construed
to do any of the following: (1) alter the scope of
practice of any licensed or certified health care provider,
(2) apply to a Low Income Health Plan, as specified, (3)
apply to public health care programs, as specified, and (4)
prevent or limit participation in activities authorized by
a federal health program or grant, as specified.
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.
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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. Defines a PCMH as a health care delivery model that
meets the following criteria:
A. Facilitates a relationship between a patient and
his or her personal physician and surgeon or other
licensed primary care provider in a
physician-directed practice team to provide
comprehensive and culturally competent primary and
preventive care;
B. Utilizes a team approach to care;
C. Delivers high-quality, comprehensive and
coordinated care including whole person orientation,
as specified;
D. Uses evidence-based medicine, patient input and
clinical decision support tools, as specified;
E. Enhances patient access to, and communication
with, his or her medical home team; and
F. Engages in continuous quality improvement, as
specified.
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2. Prohibits this bill from being construed to do any of
the following:
A. Alter the scope of practice of any licensed or
certified health care provider;
B. Apply to a Low Income Health Plan, as specified;
C. Apply to public health care programs, as
specified; and
D. Prevent or limit participation in activities
authorized by a federal health program or grant, as
specified.
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.
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According to a 2007 Commonwealth Fund report, "Closing the
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
SUPPORT : (Verified 8/29/12)
American Academy of Pediatrics (co-source)
California Academy of Family Physicians (co-source)
California Academy of Physician Assistants (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
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
OPPOSITION : (Verified 8/29/12)
Department of Health Care Services
ARGUMENTS IN SUPPORT : According to the author, this bill
establishes a definition for the set of best health care
practices known as PCMH to ensure uniform standards of
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quality and access. The author argues that out-of-control
health care costs, diminishing state revenue, a growing
shortage of primary care professionals, inadequate
distribution of health care providers, and a sharp increase
in the demand for services for those with chronic disease
and mental health disorders drive the need for the PCMH
model of health care delivery. The author maintains that
establishing a definition for this model in state law makes
it more likely that California will receive crucial federal
health care dollars.
Supporters, representing various provider and consumer
advocacy groups, agree that a medical home serves as a
centralized hub to provide patients and their families with
coordinated services, such as preventive and wellness care,
referrals for specialty care, and help in coordinating care
across specialties. They state that the PCMH model is
particularly effective for children as it encourages a
"whole child" approach that increases the ability to avoid
or successfully manage chronic childhood conditions and, in
doing so, it could produce potentially significant cost
savings over a lifetime. Supporters write that, as the
PCMH model continues to evolve and grow in popularity, this
bill will ensure uniform application of the use of the PCMH
in California and provide clarity on the appropriate
standards of care for this model in the state. They add
that this bill ensures that all licensed providers are
included as partners in the medical home model and sends an
important
signal that California supports health care that is
comprehensive, accessible, cost-effective, and
evidence-based.
DLW:m 8/29/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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