BILL ANALYSIS �
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Date of Hearing: June 10, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
ACR 152 (Pan) - As Introduced: May 22, 2014
SUBJECT : Patient centered medical homes.
SUMMARY : States that the Legislature supports and encourages
the development and expansion of a California health care
delivery system that identifies patient centered medical homes
(PCMH) and is based upon certain principles of coordination of
patient care. Specifically, this resolution makes the following
legislative findings, among others:
1)Patients frequently confront health care providers working in
independent silos that impede care coordination and cause
patients with multiple health issues to fall through the
cracks.
2)Patients are forced to navigate an exceedingly complex system
with little or no guidance, seeing multiple physicians and
other health providers in various settings.
3)The absence of accountability, quality improvement
programming, and clinical information systems leads to poorer
quality of patient care.
4)"Patient centered medical home" is a health care delivery
system model in which health care providers work in
partnership with one another, their patients, and their
patients' families to coordinate care and ensure that patients
receive the right care at the right time.
EXISTING LAW :
1)Defines PCMH under the federal Patient Protection and
Affordable Care Act (ACA) and authorizes tests of innovative
Medicaid (Medi-Cal in California) and Medicare service
delivery models in federal fiscal years 2010 to 2019, to
reduce program expenditures while preserving or enhancing
patient quality of care. Provides that innovative models
include PCMHs for high-need patients.
2)Makes grants under the ACA available to states to establish
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community-based interdisciplinary teams to support medical
homes and help primary care providers implement them in
federal fiscal years 2011 and 2012.
3)Authorizes the waiving of specified Medicaid requirements for
demonstration projects, for care delivered through primary
care case-management systems, or for the provision of home- or
community-based services.
4)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income persons receive health care benefits.
5)As of December 31, 2013, repeals the Low Income Health Program
(LIHP) which was an optional limited term program established
at the local level in California. The LIHP operated from July
1, 2011 through December 31, 2013.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . According to the author, having a
definition for "patient centered medical home" in California
would send an important signal to health care providers and
patients that our state supports care that is patient
centered, cost efficient, continuous, focused on prevention,
and based on sound, evidence-based medicine rather than
episodic, illness oriented care. The author also notes that,
with the sunset of LIHP, what little language California law
had regarding medical homes was repealed, making it even more
imperative for the state to begin to address the issue.
2)BACKGROUND . According to the American Academy of Family
Physicians (AAFP), the PCMH model is an approach to providing
comprehensive primary care for children, adolescents, and
adults. The PCMH is a health care setting that facilitates
partnerships between patients and their personal physicians,
and when appropriate, the patient's family.
This definition was laid out by the AAFP, the American College
of Physicians, the American Academy of Pediatrics, and the
American Osteopathic Association in the 2007 Joint Principles
for the Patient Centered Medical Home, which defines critical
principles within the PCMH model as:
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a) Access to a personal physician who leads the care team
within a medical practice;
b) A whole-person orientation to providing patient care;
c) Integrated and coordinated care;
d) Focus on quality and safety; and,
e) Through the medical home model, practices seek to
improve the quality, effectiveness, and efficiency of the
care they deliver, and to ensure that the activities within
the practice are focused on meeting patient needs first.
The PCMH model seeks to foster a relationship of trust
between the care team and the patient, and to actively
engage patients as partners in their health care.
3)SUPPORT . The California Academy of Family Physicians is the
sponsor of this resolution and writes that more than 40 states
have adopted medical home legislation including North
Carolina, which developed an innovative Medicaid management
program: Community Care of North Carolina. AAFP explains that
providers there offer continuous, healing relationships with
whole-person orientation and have resources to assist with
at-risk patients to better manage their care and prevent high
cost interventions and that the program was so successful that
it saved the state between $230 million and $260 million in
2004. AAFP further notes that despite other states'
successes, California has been slow to act and that out of
control health care costs and diminishing state revenue,
coupled with the high cost and low quality of
compartmentalized patient care, must be addressed if the
expanded health care coverage mandated in federal reform is to
be successful.
4)PREVIOUS LEGISLATION .
a) AB 1542 (Jones) would have established the PCMH 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. AB 1542 failed passage on the Assembly
Floor.
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b) SB 393 (Ed Hernandez) would have enacted the PCMH Act of
2011 and would have established a definition for a medical
home based upon specified standards. SB 393 was vetoed by
Governor Brown who stated in his veto message that he
commends the author for trying to improve the delivery of
health care by encouraging the greater use of PCMHs, but
argued that while this concept is not new, it is still
evolving and said he thought more work was needed before
codifying the definition contained in the bill.
c) AB 1208 (Pan), as introduced, would have established the
PCMH Act of 2013 which would have defined medical homes and
specified their characteristics. AB 1208 was amended to
address a different subject matter and was vetoed by
Governor Brown.
REGISTERED SUPPORT / OPPOSITION :
Support
California Academy of Family Physicians
Opposition
None on file.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097