PRIOR PRINTER'S NO. 3938 PRINTER'S NO. 3957
No. 2625 Session of 2008
INTRODUCED BY PALLONE, J. EVANS, TANGRETTI, DeLUCA, HORNAMAN,
DERMODY, KOTIK, FABRIZIO, HARKINS, KULA, LONGIETTI, PETRARCA,
SAINATO AND FRANKEL, JUNE 13, 2008
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, JUNE 17, 2008
AN ACT
1 Establishing the Access to Community-based Care and Extended <--
2 Safety-net Services (ACCESS) Program in the Department of
3 Health; setting criteria for eligibility for counties and
4 community-based health care providers; developing plans to
5 assure people and families with low income access to a
6 continuum of health care services on a county basis; and
7 providing for powers and duties of the Department of Public
8 Welfare and the Department of Health.
9 ESTABLISHING THE COUNTY ACCESS TO COMMUNITY-BASED CARE AND <--
10 EXTENDED SAFETY-NET SERVICES (COUNTY ACCESS) PROGRAM IN THE
11 DEPARTMENT OF HEALTH; SETTING CRITERIA FOR ELIGIBILITY FOR
12 COUNTIES AND HEALTH CARE PROVIDERS; DEVELOPING PLANS TO
13 ASSURE PEOPLE AND FAMILIES WITH LOW INCOME ACCESS TO A
14 CONTINUUM OF HEALTH CARE SERVICES ON A COUNTY BASIS; AND
15 PROVIDING FOR POWERS AND DUTIES OF THE DEPARTMENT OF PUBLIC
16 WELFARE AND THE DEPARTMENT OF INSURANCE.
17 The General Assembly of the Commonwealth of Pennsylvania
18 hereby enacts as follows:
19 Section 1. Short title. <--
20 This act shall be known and may be cited as the Access to
21 Community-based Care and Extended Safety-net Services (ACCESS)
22 Program Act.
23 Section 2. Statement of purpose.
24 The purpose of the ACCESS Program is to provide access to
1 support services to improve the health status of residents of a
2 county regardless of whether or not they can afford health
3 insurance.
4 Section 3. Definitions.
5 The following words and phrases when used in this act shall
6 have the meanings given to them in this section unless the
7 context clearly indicates otherwise:
8 "ACCESS Program." The Access to Community-based Care and
9 Extended Safety-net Services Program established under section
10 4.
11 "Chronic care model." A model that includes the following
12 elements:
13 (1) Providing patients with chronic conditions support
14 and information so they can effectively manage their health.
15 (2) Ensuring that treatment decisions by health care
16 providers are based on evidence-based medicine.
17 (3) Ensuring that patients get the care they need by
18 clarifying roles and tasks of health care providers and
19 ensuring that all who take care of patients have centralized,
20 up-to-date information about the patient and that follow-up
21 care is provided as a standard procedure.
22 (4) Tracking clinical information of individual patients
23 and a population of patients to help guide the course of
24 treatment, anticipate and track problems.
25 (5) Engaging the entire organization in the chronic care
26 improvement effort.
27 (6) Forming powerful alliances and partnerships with
28 State, local, business, religious and other organizations to
29 support or expand care for those with chronic disease.
30 "Community-based care provider." Any of the following
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1 nonprofit health care centers that provide primary health care
2 services:
3 (1) A federally qualified health center as defined under
4 section 1905(l)(2)(B) of the Social Security Act (49 Stat.
5 620, 42 U.S.C. § 1396d(l)(2)(B)).
6 (2) A rural health clinic, as defined under section
7 1861(aa)(2) of the Social Security Act (49 Stat. 620, 42
8 U.S.C. § 1395x(aa)(2)), certified by Medicare.
9 (3) A nurse-managed health center.
10 (4) A freestanding hospital-run or hospital-affiliated
11 clinic that serves a federally designated health care
12 professional shortage area.
13 (5) A free or partial-pay health clinic that provides
14 services by volunteer medical providers.
15 "Community-based health improvement partnership." A
16 partnership that is considered a State Health Improvement Plan-
17 affiliated partnership under the State Health Improvement
18 Program.
19 "Community health needs assessment." An assessment for a
20 particular county where a community-based health improvement
21 partnership is based that contains revenue and cost data or
22 other information the Department of Public Welfare determines to
23 be appropriate to ascertain the financial condition and needs of
24 families with low income to access a continuum of health care
25 services on a county-specific basis.
26 "Department." The Department of Public Welfare of the
27 Commonwealth.
28 "Health care provider." Any of the following:
29 (1) A primary care physician or a community-based health
30 care provider.
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1 (2) A health care facility or a health care practitioner
2 as defined under section 103 of the act of July 19, 1979
3 (P.L.130, No.48), known as the Health Care Facilities Act.
4 "Medical assistance." A State program of medical
5 assistance established under Article IV(f) of the act of June
6 13, 1967 (P.L.31, No.21), known as the Public Welfare Code.
7 "Nurse-managed health center." A nurse practice arrangement,
8 managed by advanced practice nurses, that provides health care
9 services to vulnerable populations and is associated with any of
10 the following:
11 (1) A school, college or department of nursing.
12 (2) A federally qualified health center.
13 (3) An independent nonprofit health or social services
14 agency.
15 "Patient." A natural person receiving health care in or from
16 a health care provider.
17 "Primary care physician." A licensed physician, including an
18 osteopathic physician, who supervises, coordinates and provides
19 initial and basic care to an enrollee on the basis of a
20 contractual relationship with the enrollee's managed care plan.
21 "State Health Improvement Plan." A health plan project
22 established by the Department of Health which has the following
23 main components:
24 (1) A health plan that places emphasis on improving the
25 health status of populations through planning that addresses
26 the root or underlying causes of premature disease, death and
27 disability.
28 (2) A plan submitted to the Department of Health that
29 lists ways that the Commonwealth can work with organized
30 community-based health improvement partnerships to coordinate
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1 resources in meaningful ways and address local health
2 improvement issues and priorities.
3 (3) A commitment to increase access to relevant data and
4 information necessary for communities to assess local health
5 status and to develop local health improvement priorities.
6 "Support services." Services that include preventative care,
7 inpatient care, outpatient care, pharmacy, drug and alcohol
8 treatment, behavioral health and transportation.
9 Section 4. Access to Community-based Care and Extended Safety-
10 net Services (ACCESS) Program.
11 (a) Establishment.--The Access to Community-based Care and
12 Extended Safety-net Services (ACCESS) Program is established
13 within the department to provide grants to community-based
14 health improvement partnerships to work with county governments,
15 the health care provider community and networks within the
16 county and the community at large to develop a plan for a system
17 that does all of the following:
18 (1) Provides outreach into the community to identify
19 people who would qualify for the program and integrates them
20 into the program.
21 (2) Provides for the establishment of a case manager
22 system for each eligible person that will assist an
23 individual in meeting the person's health care needs.
24 (3) Provides a continuous examination of reimbursement
25 systems with recommendations that focus on aligning the
26 interests of the patients and health care providers while
27 guaranteeing that a continuum of care is available for all
28 residents.
29 (4) Contains a method approved by the department for
30 measuring changes in health status of the low-income
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1 residents in the community.
2 (5) Improves access to medically necessary preventive,
3 curative and palliative physical, dental and behavioral
4 health care services offered by and through community-based
5 health care providers, while reducing unnecessary or
6 duplicative services.
7 (6) Contains a plan to implement a chronic care model
8 that includes the participation of all health care providers
9 and focuses on ways to obtain funding through commercial
10 insurers.
11 (7) Examines available resources in the county where the
12 partnership exists in order to reduce the unnecessary
13 utilization of emergency health care services by supporting
14 the development and provision of effective alternatives
15 offered by or through community-based health care providers.
16 (8) Develops methods through learning collaboratives
17 that promote the use of a chronic care model and disease
18 management protocols that link community-based health care
19 providers with other health care providers in an effort to
20 optimize both individual health outcomes and the use of
21 health care resources, including those resources offered by
22 commercial insurers.
23 (9) Determines the resources available at the Federal,
24 State and local level currently being used to pay for care
25 delivered to low-income and middle-income patients
26 (10) Develops a budget and funding mechanism to support
27 and maintain sufficient resources to implement the plan.
28 (b) Community-based health improvement partnership
29 responsibilities.--Within 12 months of receiving a grant from
30 the department, a community-based health improvement partnership
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1 shall present to the department a comprehensive plan that
2 includes all of the following:
3 (1) A statement by the county that it is willing to act
4 as a partner under the program and will assist the community-
5 based health improvement partnership in obtaining Federal and
6 State support for programs or funds.
7 (2) A description of the provider network and services
8 available, including any contracts entered into with
9 providers expected to participate in the program.
10 (3) The research design and costs associated with
11 implementing the outcomes measurement system, including a
12 community health status assessment including contracts with
13 the contractor expected to participate in the program.
14 (4) A description of how a case management system will
15 be implemented under the program and how that case management
16 system will interact with current programs established within
17 the department, the Insurance Department and the Department
18 of Health.
19 (5) An outreach plan to identify residents in the county
20 in need of services that includes a list of contracts with
21 providers or businesses that perform or will perform outreach
22 for residents to participate in the program.
23 (6) A transportation plan including contracts with
24 transportation providers expected to participate in the
25 program.
26 (7) A budget that includes the identification of sources
27 of revenue currently being used to pay for services for the
28 community as well as a statement of additional revenues that
29 may be needed to successfully meet the objectives of the
30 program and identification and commitment from future funding
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1 sources.
2 (c) Department responsibilities.--The department shall be
3 responsible for the following:
4 (1) Administering the program.
5 (2) Within 90 days of the effective date of this
6 section, developing and providing an application form
7 consistent with the requirements of this act.
8 (3) Determining the eligibility of community-based
9 health improvement partnerships for grants provided under
10 this act based upon submission of a community health needs
11 assessment that proposes to link health care providers with
12 the county in an effort to develop a continuum of care for
13 residents.
14 (4) Coordinating efforts with the Department of Health
15 and the Insurance Department in awarding grants.
16 (5) Approving the comprehensive plan submitted under
17 subsection (b) and providing technical support to implement
18 that comprehensive plan.
19 (6) Developing a plan that links counties together in
20 the sharing of health care services when those services are
21 nonexistent or heavily used in a particular county.
22 (7) Approving the budget for the comprehensive plan
23 submitted under subsection (b) and working with the county to
24 access funds from sources identified to finance the
25 implementation and operation of the comprehensive plan.
26 (d) County responsibilities.--An application to the
27 department for a grant under this act shall contain a statement
28 that the county in which the community-based health improvement
29 partnership is located or is agreeing to provide services shall
30 agree to be responsible for all of the following:
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1 (1) The selection of a contractor that shall develop
2 outreach programs that identify residents in need of the
3 ACCESS Program.
4 (2) The selection of a contractor that shall be
5 responsible for making sure that the clinical and other
6 health care needs of the low-income residents are being met
7 throughout the continuum by health care providers.
8 (3) Contracting with health care providers to guarantee
9 that the residents and patients have access to the most
10 complete and comprehensible range of health care and other
11 related services available.
12 (4) Creating an outcomes measurement for the program,
13 including measuring the health status of the county prior to
14 the implementation of the program and at three-year intervals
15 thereafter, to evaluate the effectiveness of the program in
16 meeting the health care needs of the community.
17 (5) Managing the program to stay within budget limits
18 agreed to with the department and the Department of Health.
19 Section 5. Reports.
20 A community-based health improvement partnership that
21 receives a grant under this act shall annually submit a report
22 to the department. The report shall include a description of all
23 of the following:
24 (1) The community-based health care provider's efforts
25 to improve access to and the delivery and management of
26 health care services.
27 (2) The reduction of unnecessary and duplicative health
28 care services.
29 (3) Changes in overall health indicators and in
30 utilization of health care services among the communities and
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1 individuals served by the community-based health care
2 providers, with particular emphasis on indicators, including
3 all of the following:
4 (i) The creation and maintenance of relationships
5 among and between primary care providers, hospitals and
6 the county that lead to individuals being able to access
7 various services that include, at a minimum, preventive
8 and chronic care management services.
9 (ii) Prenatal and postpartum care.
10 (iii) The care of newborns and infants.
11 (iv) Any other matters as may be specified by the
12 department.
13 (4) An accounting of the expenditure of funds from the
14 grant and all funds received from other sources.
15 Section 6. Federal funds.
16 The department shall seek Federal matching funds to
17 supplement amounts made available under this act.
18 Section 7. State program.
19 Nothing in the act shall prevent the use of a State program
20 or an element of a State program in any part listed under the
21 comprehensive plan submitted by a community-based health
22 improvement partnership under section 4(b).
23 Section 8. Multiple community-based health improvement
24 partnerships.
25 Two or more community-based health improvement partnerships
26 may join in submitting an application for a grant under this
27 act.
28 Section 30. Effective date.
29 This act shall take effect July 1, 2008, or immediately,
30 whichever is later.
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1 SECTION 1. SHORT TITLE. <--
2 THIS ACT SHALL BE KNOWN AND MAY BE CITED AS THE COUNTY ACCESS
3 TO COMMUNITY-BASED CARE AND EXTENDED SAFETY-NET SERVICES (COUNTY
4 ACCESS) PROGRAM ACT.
5 SECTION 2. STATEMENT OF PURPOSE.
6 THE PURPOSE OF THE COUNTY ACCESS PROGRAM IS TO PROVIDE ACCESS
7 TO SUPPORT SERVICES TO IMPROVE THE HEALTH STATUS OF RESIDENTS OF
8 A COUNTY REGARDLESS OF WHETHER OR NOT THEY CAN AFFORD HEALTH
9 INSURANCE.
10 SECTION 3. DEFINITIONS.
11 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ACT SHALL
12 HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
13 CONTEXT CLEARLY INDICATES OTHERWISE:
14 "ADVANCED PRACTICE NURSE." A REGISTERED NURSE WITH A
15 MASTER'S OR DOCTORATE DEGREE LICENSED TO PRACTICE AS A CERTIFIED
16 REGISTERED NURSE PRACTITIONER, CLINICAL NURSE SPECIALIST OR
17 CERTIFIED NURSE-MIDWIFE.
18 "CHRONIC CARE MODEL." A MODEL THAT INCLUDES THE FOLLOWING
19 ELEMENTS:
20 (1) PROVIDING PATIENTS WITH CHRONIC CONDITIONS SUPPORT
21 AND INFORMATION SO THEY CAN EFFECTIVELY MANAGE THEIR HEALTH.
22 (2) ENSURING THAT TREATMENT DECISIONS BY HEALTH CARE
23 PROVIDERS ARE BASED ON EVIDENCE-BASED MEDICINE.
24 (3) ENSURING THAT PATIENTS GET THE CARE THEY NEED BY
25 CLARIFYING ROLES AND TASKS OF HEALTH CARE PROVIDERS AND
26 ENSURING THAT ALL WHO TAKE CARE OF PATIENTS HAVE CENTRALIZED,
27 UP-TO-DATE INFORMATION ABOUT THE PATIENT AND THAT FOLLOW-UP
28 CARE IS PROVIDED AS A STANDARD PROCEDURE.
29 (4) TRACKING CLINICAL INFORMATION OF INDIVIDUAL PATIENTS
30 AND A POPULATION OF PATIENTS TO HELP GUIDE THE COURSE OF
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1 TREATMENT, ANTICIPATE AND TRACK PROBLEMS.
2 (5) ENGAGING THE ENTIRE ORGANIZATION IN THE CHRONIC CARE
3 IMPROVEMENT EFFORT.
4 (6) FORMING POWERFUL ALLIANCES AND PARTNERSHIPS WITH
5 STATE, LOCAL, BUSINESS, RELIGIOUS AND OTHER ORGANIZATIONS TO
6 SUPPORT OR EXPAND CARE FOR THOSE WITH CHRONIC DISEASE.
7 "COMMUNITY-BASED CARE PROVIDER." ANY OF THE FOLLOWING
8 NONPROFIT HEALTH CARE CENTERS THAT PROVIDE PRIMARY HEALTH CARE
9 SERVICES:
10 (1) A FEDERALLY QUALIFIED HEALTH CENTER AS DEFINED UNDER
11 SECTION 1905(L)(2)(B) OF THE SOCIAL SECURITY ACT (49 STAT.
12 620, 42 U.S.C. § 1396D(L)(2)(B)).
13 (2) A RURAL HEALTH CLINIC, AS DEFINED UNDER SECTION
14 1861(AA)(2) OF THE SOCIAL SECURITY ACT (49 STAT. 620, 42
15 U.S.C. § 1395X(AA)(2)), CERTIFIED BY MEDICARE.
16 (3) A NURSE-MANAGED HEALTH CENTER.
17 (4) A FREESTANDING HOSPITAL-RUN OR HOSPITAL-AFFILIATED
18 CLINIC THAT SERVES A FEDERALLY DESIGNATED HEALTH CARE
19 PROFESSIONAL SHORTAGE AREA.
20 (5) A FREE OR PARTIAL-PAY HEALTH CLINIC THAT PROVIDES
21 SERVICES BY VOLUNTEER MEDICAL PROVIDERS.
22 "COMMUNITY-BASED HEALTH IMPROVEMENT PARTNERSHIP." A
23 PARTNERSHIP THAT IS CONSIDERED A STATE HEALTH IMPROVEMENT PLAN-
24 AFFILIATED PARTNERSHIP UNDER THE STATE HEALTH IMPROVEMENT
25 PROGRAM.
26 "COMMUNITY HEALTH NEEDS ASSESSMENT" OR "ASSESSMENT." AN
27 ASSESSMENT CONDUCTED BY A COMMUNITY-BASED HEALTH IMPROVEMENT
28 PARTNERSHIP UNDER SECTION 4.
29 "COUNTY ACCESS PROGRAM." THE COUNTY ACCESS TO COMMUNITY-
30 BASED CARE AND EXTENDED SAFETY-NET SERVICES PROGRAM ESTABLISHED
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1 UNDER SECTION 4.
2 "DEPARTMENT." THE DEPARTMENT OF PUBLIC WELFARE OF THE
3 COMMONWEALTH.
4 "HEALTH CARE PROVIDER." ANY OF THE FOLLOWING:
5 (1) A PRIMARY CARE PHYSICIAN OR A COMMUNITY-BASED HEALTH
6 CARE PROVIDER.
7 (2) A HEALTH CARE FACILITY OR A HEALTH CARE PRACTITIONER
8 AS DEFINED UNDER SECTION 103 OF THE ACT OF JULY 19, 1979
9 (P.L.130, NO.48), KNOWN AS THE HEALTH CARE FACILITIES ACT.
10 "NURSE-MANAGED HEALTH CENTER." A NURSE PRACTICE ARRANGEMENT,
11 MANAGED BY ADVANCED PRACTICE NURSES, THAT PROVIDES HEALTH CARE
12 SERVICES TO VULNERABLE POPULATIONS AND IS ASSOCIATED WITH ANY OF
13 THE FOLLOWING:
14 (1) A SCHOOL, COLLEGE OR DEPARTMENT OF NURSING.
15 (2) A FEDERALLY QUALIFIED HEALTH CENTER.
16 (3) AN INDEPENDENT NONPROFIT HEALTH OR SOCIAL SERVICES
17 AGENCY.
18 "PATIENT." A NATURAL PERSON RECEIVING HEALTH CARE IN OR FROM
19 A HEALTH CARE PROVIDER.
20 "PRIMARY CARE PHYSICIAN." A LICENSED PHYSICIAN, INCLUDING AN
21 OSTEOPATHIC PHYSICIAN, WHO SUPERVISES, COORDINATES AND PROVIDES
22 INITIAL AND BASIC CARE TO A PATIENT.
23 "STATE HEALTH IMPROVEMENT PLAN." A HEALTH PLAN PROJECT
24 ESTABLISHED BY THE DEPARTMENT OF HEALTH WHICH HAS THE FOLLOWING
25 MAIN COMPONENTS:
26 (1) A HEALTH PLAN THAT PLACES EMPHASIS ON IMPROVING THE
27 HEALTH STATUS OF POPULATIONS THROUGH PLANNING THAT ADDRESSES
28 THE ROOT OR UNDERLYING CAUSES OF PREMATURE DISEASE, DEATH AND
29 DISABILITY.
30 (2) A PLAN SUBMITTED TO THE DEPARTMENT OF HEALTH THAT
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1 LISTS WAYS THAT THE COMMONWEALTH CAN WORK WITH ORGANIZED
2 COMMUNITY-BASED HEALTH IMPROVEMENT PARTNERSHIPS TO COORDINATE
3 RESOURCES IN MEANINGFUL WAYS AND ADDRESS LOCAL HEALTH
4 IMPROVEMENT ISSUES AND PRIORITIES.
5 (3) A COMMITMENT TO INCREASE ACCESS TO RELEVANT DATA AND
6 INFORMATION NECESSARY FOR COMMUNITIES TO ASSESS LOCAL HEALTH
7 STATUS AND TO DEVELOP LOCAL HEALTH IMPROVEMENT PRIORITIES.
8 "SUPPORT SERVICES." SERVICES THAT INCLUDE PREVENTATIVE CARE,
9 INPATIENT CARE, OUTPATIENT CARE, PHARMACY, DRUG AND ALCOHOL
10 TREATMENT, BEHAVIORAL HEALTH AND TRANSPORTATION.
11 SECTION 4. COUNTY ACCESS TO COMMUNITY-BASED CARE AND EXTENDED
12 SAFETY-NET SERVICES (COUNTY ACCESS) PROGRAM.
13 (A) ESTABLISHMENT.--THE COUNTY ACCESS TO COMMUNITY-BASED
14 CARE AND EXTENDED SAFETY-NET SERVICES (COUNTY ACCESS) PROGRAM IS
15 ESTABLISHED WITHIN THE DEPARTMENT TO PROVIDE GRANTS TO
16 COMMUNITY-BASED HEALTH IMPROVEMENT PARTNERSHIPS TO CONDUCT A
17 COMMUNITY HEALTH NEEDS ASSESSMENT THAT RESULTS IN LINKING COUNTY
18 GOVERNMENTS, THE HEALTH CARE PROVIDER COMMUNITY AND NETWORKS
19 WITHIN THE COUNTY AND THE COMMUNITY AT LARGE TO DEVELOP A PLAN
20 FOR A SYSTEM THAT DOES ALL OF THE FOLLOWING:
21 (1) PROVIDES OUTREACH INTO THE COMMUNITY TO IDENTIFY
22 PEOPLE WHO WOULD QUALIFY FOR THE PROGRAM AND INTEGRATES THEM
23 INTO THE COUNTY ACCESS PROGRAM.
24 (2) PROVIDES FOR THE ESTABLISHMENT OF A CASE MANAGER
25 SYSTEM FOR EACH ELIGIBLE PERSON THAT WILL ASSIST AN
26 INDIVIDUAL IN MEETING THE PERSON'S HEALTH CARE NEEDS.
27 (3) PROVIDES A CONTINUOUS EXAMINATION OF REIMBURSEMENT
28 SYSTEMS WITH RECOMMENDATIONS THAT FOCUS ON ALIGNING THE
29 INTERESTS OF THE PATIENTS AND HEALTH CARE PROVIDERS WHILE
30 GUARANTEEING THAT A CONTINUUM OF CARE IS AVAILABLE FOR ALL
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1 RESIDENTS.
2 (4) CONTAINS A METHOD APPROVED BY THE DEPARTMENT FOR
3 MEASURING CHANGES IN HEALTH STATUS OF THE LOW-INCOME
4 RESIDENTS IN THE COMMUNITY.
5 (5) IMPROVES ACCESS TO MEDICALLY NECESSARY PREVENTIVE,
6 CURATIVE AND PALLIATIVE PHYSICAL, DENTAL AND BEHAVIORAL
7 HEALTH CARE SERVICES OFFERED BY AND THROUGH COMMUNITY-BASED
8 HEALTH CARE PROVIDERS, WHILE REDUCING UNNECESSARY OR
9 DUPLICATIVE SERVICES.
10 (6) EXAMINES AVAILABLE RESOURCES IN THE COUNTY WHERE THE
11 PARTNERSHIP EXISTS IN ORDER TO REDUCE THE UNNECESSARY
12 UTILIZATION OF EMERGENCY HEALTH CARE SERVICES BY SUPPORTING
13 THE DEVELOPMENT AND PROVISION OF EFFECTIVE ALTERNATIVES
14 OFFERED BY OR THROUGH COMMUNITY-BASED HEALTH CARE PROVIDERS.
15 (7) DEVELOPS METHODS THROUGH LEARNING COLLABORATIVES
16 THAT IMPLEMENT THE USE OF A CHRONIC CARE MODEL AND DISEASE
17 MANAGEMENT PROTOCOLS THAT LINK HEALTH CARE PROVIDERS WITH
18 OTHER HEALTH CARE PROVIDERS IN AN EFFORT TO OPTIMIZE BOTH
19 INDIVIDUAL HEALTH OUTCOMES AND THE USE OF HEALTH CARE
20 RESOURCES, INCLUDING FINANCIAL RESOURCES THROUGH COMMERCIAL
21 INSURERS.
22 (8) DETERMINES THE RESOURCES AVAILABLE AT THE FEDERAL,
23 STATE AND LOCAL LEVEL CURRENTLY BEING USED TO PAY FOR CARE
24 DELIVERED TO LOW-INCOME AND MIDDLE-INCOME PATIENTS
25 (9) DEVELOPS A BUDGET AND FUNDING MECHANISM TO SUPPORT
26 AND MAINTAIN SUFFICIENT RESOURCES TO IMPLEMENT THE
27 ASSESSMENT.
28 (B) COMMUNITY-BASED HEALTH IMPROVEMENT PARTNERSHIP
29 RESPONSIBILITIES.--WITHIN 12 MONTHS OF RECEIVING A GRANT FROM
30 THE DEPARTMENT, A COMMUNITY-BASED HEALTH IMPROVEMENT PARTNERSHIP
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1 SHALL PRESENT TO THE DEPARTMENT AN ASSESSMENT THAT MEETS THE
2 REQUIREMENTS OF SECTION 4 AND THAT INCLUDES ALL OF THE
3 FOLLOWING:
4 (1) A STATEMENT BY THE COUNTY THAT IT IS WILLING TO ACT
5 AS A PARTNER UNDER THE COUNTY ACCESS PROGRAM AND WILL ASSIST
6 THE COMMUNITY-BASED HEALTH IMPROVEMENT PARTNERSHIP IN
7 OBTAINING FEDERAL AND STATE SUPPORT FOR PROGRAMS OR FUNDS.
8 (2) A DESCRIPTION OF THE PROVIDER NETWORK AND SERVICES
9 AVAILABLE, INCLUDING ANY CONTRACTS CURRENTLY ENTERED INTO
10 WITH PROVIDERS EXPECTED TO PARTICIPATE IN THE COUNTY ACCESS
11 PROGRAM.
12 (3) THE RESEARCH DESIGN AND COSTS ASSOCIATED WITH
13 IMPLEMENTING AN OUTCOMES MEASUREMENT SYSTEM.
14 (4) A DESCRIPTION OF HOW A CASE MANAGEMENT SYSTEM WILL
15 BE IMPLEMENTED UNDER THE COUNTY ACCESS PROGRAM AND HOW THAT
16 CASE MANAGEMENT SYSTEM WILL INTERACT WITH CURRENT PROGRAMS
17 ESTABLISHED WITHIN THE DEPARTMENT, THE INSURANCE DEPARTMENT
18 AND THE DEPARTMENT OF PUBLIC WELFARE.
19 (5) AN OUTREACH PLAN TO IDENTIFY RESIDENTS IN THE COUNTY
20 IN NEED OF SERVICES THAT INCLUDES A LIST OF CONTRACTS WITH
21 PROVIDERS OR BUSINESSES THAT PERFORM OR WILL PERFORM OUTREACH
22 FOR RESIDENTS TO PARTICIPATE IN THE COUNTY ACCESS PROGRAM.
23 (C) DEPARTMENT RESPONSIBILITIES.--THE DEPARTMENT SHALL BE
24 RESPONSIBLE FOR THE FOLLOWING:
25 (1) ADMINISTERING THE COUNTY ACCESS PROGRAM.
26 (2) WITHIN 90 DAYS OF THE EFFECTIVE DATE OF THIS
27 SECTION, DEVELOPING AND PROVIDING AN APPLICATION FORM
28 CONSISTENT WITH THE REQUIREMENTS OF THIS ACT.
29 (3) COORDINATING EFFORTS WITH THE DEPARTMENT OF PUBLIC
30 WELFARE AND THE INSURANCE DEPARTMENT IN AWARDING GRANTS.
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1 (4) APPROVING THE ASSESSMENT SUBMITTED UNDER SUBSECTION
2 (B) AND PROVIDING TECHNICAL SUPPORT TO IMPLEMENT THAT
3 ASSESSMENT.
4 (5) DEVELOPING A PLAN THAT LINKS COUNTIES TOGETHER IN
5 THE SHARING OF HEALTH CARE SERVICES WHEN THOSE SERVICES ARE
6 NONEXISTENT OR HEAVILY USED IN A PARTICULAR COUNTY.
7 (6) APPROVING THE BUDGET FOR THE ASSESSMENT SUBMITTED
8 UNDER SUBSECTION (B) AND WORKING WITH THE COUNTY TO OBTAIN
9 FUNDS FROM SOURCES IDENTIFIED TO FINANCE THE IMPLEMENTATION
10 AND OPERATION OF THE ASSESSMENT.
11 (D) COUNTY RESPONSIBILITIES.--AN APPLICATION TO THE
12 DEPARTMENT FOR A GRANT UNDER THIS ACT SHALL CONTAIN A STATEMENT
13 THAT THE COUNTY IN WHICH THE COMMUNITY-BASED HEALTH IMPROVEMENT
14 PARTNERSHIP IS LOCATED OR IS IMPLEMENTING THE ASSESSMENT SHALL
15 AGREE TO BE RESPONSIBLE WHEN FUNDING IS AVAILABLE FOR ALL OF THE
16 FOLLOWING:
17 (1) THE SELECTION OF A CONTRACTOR THAT SHALL DEVELOP
18 OUTREACH PROGRAMS THAT IDENTIFY RESIDENTS IN NEED OF THE
19 COUNTY ACCESS PROGRAM.
20 (2) THE SELECTION OF A CONTRACTOR THAT SHALL BE
21 RESPONSIBLE FOR MAKING SURE THAT THE CLINICAL AND OTHER
22 HEALTH CARE NEEDS OF THE UNINSURED AND UNDERINSURED RESIDENTS
23 ARE BEING MET THROUGHOUT THE CONTINUUM BY HEALTH CARE
24 PROVIDERS.
25 (3) CONTRACTING WITH HEALTH CARE PROVIDERS TO GUARANTEE
26 THAT THE RESIDENTS AND PATIENTS HAVE ACCESS TO THE MOST
27 COMPLETE AND COMPREHENSIBLE RANGE OF HEALTH CARE AND OTHER
28 RELATED SERVICES AVAILABLE.
29 (4) CREATING AN OUTCOMES MEASUREMENT FOR THE COUNTY
30 ACCESS PROGRAM, INCLUDING MEASURING THE HEALTH STATUS OF THE
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1 COUNTY PRIOR TO THE IMPLEMENTATION OF THE COUNTY ACCESS
2 PROGRAM AND AT THREE-YEAR INTERVALS THEREAFTER, TO EVALUATE
3 THE EFFECTIVENESS OF THE PROGRAM IN MEETING THE HEALTH CARE
4 NEEDS OF THE COMMUNITY.
5 (5) MANAGING THE COUNTY ACCESS PROGRAM TO STAY WITHIN
6 BUDGET LIMITS AGREED TO WITH THE DEPARTMENT AND THE
7 DEPARTMENT OF PUBLIC WELFARE.
8 SECTION 5. REPORTS.
9 UPON DETERMINATION OF AN ASSESSMENT, A COMMUNITY-BASED HEALTH
10 IMPROVEMENT PARTNERSHIP THAT RECEIVES A GRANT UNDER THIS ACT
11 SHALL ANNUALLY SUBMIT A REPORT TO THE DEPARTMENT. THE REPORT
12 SHALL INCLUDE A DESCRIPTION OF ALL OF THE FOLLOWING:
13 (1) THE HEALTH CARE PROVIDER'S EFFORTS TO IMPROVE ACCESS
14 TO AND THE DELIVERY AND MANAGEMENT OF HEALTH CARE SERVICES.
15 (2) THE REDUCTION OF UNNECESSARY AND DUPLICATIVE HEALTH
16 CARE SERVICES.
17 (3) CHANGES IN OVERALL HEALTH INDICATORS AND IN
18 UTILIZATION OF HEALTH CARE SERVICES AMONG THE RESIDENTS AND
19 PATIENTS SERVED BY THE COMMUNITY-BASED HEALTH CARE PROVIDERS,
20 WITH PARTICULAR EMPHASIS ON INDICATORS, INCLUDING ALL OF THE
21 FOLLOWING:
22 (I) THE CREATION AND MAINTENANCE OF RELATIONSHIPS
23 AMONG AND BETWEEN PRIMARY CARE PROVIDERS, HOSPITALS AND
24 THE COUNTY THAT LEAD TO INDIVIDUALS BEING ABLE TO ACCESS
25 VARIOUS SERVICES THAT INCLUDE, AT A MINIMUM, PREVENTIVE
26 AND CHRONIC CARE MANAGEMENT SERVICES.
27 (II) PRENATAL AND POSTPARTUM CARE.
28 (III) THE CARE OF NEWBORNS AND INFANTS.
29 (IV) ANY OTHER MATTERS AS MAY BE SPECIFIED BY THE
30 DEPARTMENT.
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1 SECTION 6. FEDERAL FUNDS.
2 THE DEPARTMENT, IN CONSULTATION WITH THE DEPARTMENT OF PUBLIC
3 WELFARE, SHALL SEEK FEDERAL FUNDS TO SUPPLEMENT AMOUNTS MADE
4 AVAILABLE UNDER THIS ACT.
5 SECTION 7. STATE PROGRAM.
6 NOTHING IN THIS ACT SHALL PREVENT THE USE OF A STATE PROGRAM
7 OR AN ELEMENT OF A STATE PROGRAM IN ANY PART LISTED UNDER THE
8 ASSESSMENT SUBMITTED BY A COMMUNITY-BASED HEALTH IMPROVEMENT
9 PARTNERSHIP UNDER SECTION 4(B).
10 SECTION 8. MULTIPLE COMMUNITY-BASED HEALTH IMPROVEMENT
11 PARTNERSHIPS.
12 TWO OR MORE COMMUNITY-BASED HEALTH IMPROVEMENT PARTNERSHIPS
13 MAY JOIN IN SUBMITTING AN APPLICATION FOR A GRANT UNDER THIS
14 ACT.
15 SECTION 9. AWARD OF GRANTS.
16 THE AMOUNT AWARDED FOR ANY INDIVIDUAL GRANT UNDER THIS ACT
17 MAY NOT EXCEED $500,000.
18 SECTION 10. FUNDING.
19 GRANTS TO COMMUNITY-BASED HEALTH IMPROVEMENT PARTNERSHIPS FOR
20 CONDUCTING ASSESSMENTS UNDER THIS ACT SHALL NOT EXCEED THE
21 AMOUNT OF FUNDS APPROPRIATED FOR THE COUNTY ACCESS PROGRAM.
22 SECTION 30. EFFECTIVE DATE.
23 THIS ACT SHALL TAKE EFFECT JULY 1, 2008, OR IMMEDIATELY,
24 WHICHEVER IS LATER.
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