1Establishing the Patient-Centered Medical Home Advisory Council;
2providing powers and duties of the council, the Department of
3Public Welfare, the Insurance Department and the Department
4of Health; and providing for development of a plan to
5implement a Statewide medical home model.

6The General Assembly of the Commonwealth of Pennsylvania
7hereby enacts as follows:

8Section 1. Short title.

9This act shall be known and may be cited as the Patient-
10Centered Medical Home Advisory Council Act.

11Section 2. Definitions.

12The following words and phrases when used in this act shall
13have the meanings given to them in this section unless the
14context clearly indicates otherwise:

15"Alternative therapy." The term includes, but is not limited
16to, chiropractic therapy, biofeedback, acupuncture or massage
17therapy.

18"Council." The Patient-Centered Medical Home Advisory
19Council established by this act.

1"Department." The Department of Public Welfare of the
2Commonwealth.

3"Health care professional." A person who is licensed,
4certified or otherwise authorized or permitted by the law of
5this Commonwealth to administer health care in the ordinary
6course of business or in the practice of a profession.

7"Patient-centered medical home." A physician-led team
8approach to providing health care that:

9(1) originates in a primary care setting;

10(2) fosters a partnership among the patient, the
11personal provider and other health care professionals and,
12where appropriate, the patient's family;

13(3) utilizes the partnership to access all medical-
14health-related services and nonmedical-health-related
15services needed by the patient to achieve maximum health
16potential; and

17(4) maintains a centralized, comprehensive record of all
18health related services to promote continuity of care.

19"Primary care." Health care that emphasizes a patient's
20general health needs and utilizes collaboration with other
21health care professionals and consultation or referral as
22appropriate to meet the needs identified.

23"Primary care physician." Any of the following who provide
24primary care and meet certification standards:

25(1) a physician who is a family or general practitioner;

26(2) a pediatrician;

27(3) an internist;

28(4) an obstetrician; or

29(5) a gynecologist.

30"Telemedicine." The use of telecommunication and information

1technology in order to provide clinical health care at a
2distance.

3Section 3. Patient-Centered Medical Home Advisory Council.

4The Patient-Centered Medical Home Advisory Council is
5established. The council shall advise the department on how
6Pennsylvania's Medicaid program can increase the quality of care
7while containing costs through the following Patient-Centered
8Medical Home model approaches:

9(1) Coordinate and provide access to evidence-based
10health care services, emphasizing convenient, comprehensive
11primary care and including preventive, screening and well-
12child health services.

13(2) Provide access to appropriate specialty care, mental
14health services, inpatient services and any evidence-based
15alternative therapies.

16(3) Provide quality-driven and cost-effective health
17care.

18(4) Provide access to medication and medication therapy
19management services, where appropriate.

20(5) Promote strong and effective medical management,
21including, but not limited to, planning treatment strategies,
22monitoring health outcomes and resource use, sharing
23information and organizing care to avoid duplication of
24services, including the use of electronic medical records. In
25sharing information, the protection of the privacy of
26individuals and of the individual's information shall be
27priorities. In addition to any and all other Federal and
28State provisions for the confidentiality of health care
29information, any information-sharing required by a medical
30home system shall be subject to written consent of the

1patient.

2(6) Provide comprehensive care management to patients to
3align and assist with treatment strategies, health outcomes,
4resource utilization and organization of care and address
5determinants of health impeding goals of care.

6(7) Emphasize patient and provider accountability.

7(8) Prioritize access to the continuum of health care
8services in the most appropriate setting and in the most
9cost-effective manner.

10(9) Establish a baseline for medical home goals and
11establish performance measures that indicate a patient has an
12established and effective medical home. These goals and
13performance measures may include, but need not be limited to,
14childhood immunization rates, well-child care utilization
15rates, care management for chronic illnesses and emergency
16room utilization.

17Section 4. Council development, composition and duties.

18(a) Meetings.--The department shall establish and coordinate
19meetings of the Medical Home System Advisory Council. The
20members of the council shall not be paid but shall be reimbursed
21for reasonable expenses and shall consist of the following
22members and any other members the department determines
23necessary to assist in the department's duties:

24(1) The Secretary of Public Welfare, or a designee.

25(2) A representative of the Pennsylvania Academy of
26Family Physicians.

27(3) A representative of the Pennsylvania section of the
28American Congress of Obstetricians and Gynecologists.

29(4) A representative of the Pennsylvania Coalition of
30Nurse Practitioners.

1(5) A representative of the Pennsylvania Chapter of the
2American College of Physicians.

3(6) A representative of the Pennsylvania Chapter of the
4American Academy of Pediatrics.

5(7) A representative of the Pennsylvania Medical
6Society.

7(8) A representative of the Pennsylvania Pharmacists
8Association.

9(9) A representative of the Hospital and Health System
10Association of Pennsylvania.

11(b) Organizational model.--The council shall recommend to
12the department an organizational model for the patient-centered
13medical home system in this Commonwealth, including possible
14Medicaid pilot projects. The organizational model shall provide
15a strategy to coordinate health care services and provide for
16monitoring and data collection on patient-centered medical
17homes, for training and education to health care professionals
18and families and for transition of children to the adult medical
19care system. The organizational model may also include the use
20of telemedicine resources and may provide for partnering with
21pediatric and family practice residency programs to improve
22access to preventive care for children. The organizational
23structure shall also address the need to organize and provide
24health care to increase accessibility for patients, including
25using venues more accessible to patients and having hours of
26operation that are conducive to the population served.

27(c) Standards.--

28(1) The council shall recommend to the department
29standards and a process to certify patient-centered medical
30homes based on standards developed by a number of

1nongovernmental accrediting entities such as the National
2Committee for Quality Assurance and Accreditation Association
3for Ambulatory Health Care. The certification process and
4standards shall provide mechanisms to monitor performance and
5to evaluate, promote and improve the quality of health of,
6and health care delivered to, patients through a patient-
7centered medical home. The standards and process shall also
8include a mechanism for other ancillary service providers to
9become affiliated with a certified patient-centered medical
10home.

11(2) The council shall recommend to the department
12education and training standards for health care
13professionals participating in the patient-centered medical
14home system.

15(d) Reimbursement methodology.--The council shall recommend
16to the department a reimbursement methodology and incentives for
17participation in the patient-centered medical home system
18sufficient to ensure that providers enter and remain
19participating in the system and to promote wellness, prevention,
20chronic care management, immunizations, health care management
21and the use of electronic health records and other pertinent
22concerns. In developing the recommendations, the council shall
23consider the feasibility of all of the following:

24(1) Reimbursement under the medical assistance program
25to promote wellness and prevention and to provide care
26coordination and chronic care management.

27(2) Increasing to Medicare levels the reimbursement for
28certain wellness and prevention services, chronic care
29management and immunizations.

30(3) Reducing the disparities between reimbursement for

1specialty services and primary care services.

2(4) Increased funding for efforts to transform medical
3practices into patient-centered medical homes, including the
4use of electronic health records.

5(5) Linking provider reimbursement rates to health care
6quality improvement measures established by the department.

7(6) Providing reimbursement for medication
8reconciliation and medication therapy management service.

9Section 5. Effective date.

10This act shall take effect immediately.