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

1Council established by this act.

2"Department." The Department of Public Welfare of the
3Commonwealth.

4"Health care professional." A person who is licensed,
5certified or otherwise authorized or permitted by the law of
6this Commonwealth to administer health care in the ordinary
7course of business or in the practice of a profession.

8"Patient-centered medical home." A <-physician-led team
9approach to providing health care that:

<-10(1) is physician-led or led by a nurse practitioner 
11practicing under a collaborative agreement as required by the 
12act of May 22, 1951 (P.L.317, No.69), known as The 
13Professional Nursing Law.

<-14(1) (2) originates in a primary care setting;

<-15(2) (3) fosters a partnership among the patient, the
16personal provider and other health care professionals and,
17where appropriate, the patient's family;

<-18(3) (4) utilizes the partnership to access all medical-
19health-related services and nonmedical-health-related
20services needed by the patient to achieve maximum health
21potential; and

<-22(4) (5) maintains a centralized, comprehensive record of
23all health related services to promote continuity of care.

24"Primary care." Health care that emphasizes a patient's
25general health needs and utilizes collaboration with other
26health care professionals and consultation or referral as
27appropriate to meet the needs identified.

28"Primary care physician." Any of the following who provide
29primary care and meet certification standards:

30(1) a physician who is a family or general practitioner;

1(2) a pediatrician;

2(3) an internist;

3(4) an obstetrician; or

4(5) a gynecologist.

<-5"Secretary." The Secretary of Public Welfare of the
6Commonwealth.

7"Telemedicine." The use of telecommunication and information
8technology in order to provide clinical health care at a
9distance.

10Section 3. Patient-Centered Medical Home Advisory Council.

<-11(a) Establishment.--The Patient-Centered Medical Home
12Advisory Council is established. The council shall advise the
13department on how Pennsylvania's Medicaid program can increase
14the quality of care while containing costs through the following
15Patient-Centered Medical Home model approaches:

16(1) Coordinate and provide access to evidence-based
17health care services, emphasizing convenient, comprehensive
18primary care and including preventive, screening and well-
19child health services.

20(2) Provide access to appropriate specialty care, mental
21health services, inpatient services and any evidence-based
22alternative therapies.

23(3) Provide quality-driven and cost-effective health
24care.

25(4) Provide access to medication and medication therapy
26management services, where appropriate.

27(5) Promote strong and effective medical management,
28including, but not limited to, planning treatment strategies,
29monitoring health outcomes and resource use, sharing
30information and organizing care to avoid duplication of

1services, including the use of electronic medical records. In
2sharing information, the protection of the privacy of
3individuals and of the individual's information shall be
4priorities. In addition to any and all other Federal and
5State provisions for the confidentiality of health care
6information, any information-sharing required by a medical
7home system shall be subject to written consent of the
8patient.

9(6) Provide comprehensive care management to patients to
10align and assist with treatment strategies, health outcomes,
11resource utilization and organization of care and address
12determinants of health impeding goals of care.

13(7) Emphasize patient and provider accountability.

14(8) Prioritize access to the continuum of health care
15services in the most appropriate setting and in the most
16cost-effective manner.

17(9) Establish a baseline for medical home goals and
18establish performance measures that indicate a patient has an
19established and effective medical home. These goals and
20performance measures may include, but need not be limited to,
21childhood immunization rates, well-child care utilization
22rates, care management for chronic illnesses and emergency
23room utilization.

<-24Section 4. Council development, composition and duties.

25(a) Meetings.--The department shall establish and coordinate
26meetings of the Medical Home System Advisory Council. The
27members of the council shall not be paid but shall be reimbursed
28for reasonable expenses and shall consist of the following
29members and any other members the department determines
30necessary to assist in the department's duties:

<-1(b) Composition.--The secretary shall appoint the members of
2the council, in consultation with the President pro tempore of
3the Senate, the Majority Leader of the Senate, the Minority
4Leader of the Senate, the Speaker of the House of
5Representatives, the Majority Leader of the House of
6Representatives and the Minority Leader of the House of
7Representatives, who shall consist of the following:

8(1) The <-Secretary of Public Welfare secretary, or a
9designee.

10(2) A representative of the Pennsylvania Academy of
11Family Physicians.

12(3) A representative of the Pennsylvania section of the
13American Congress of Obstetricians and Gynecologists.

14(4) A representative of the Pennsylvania Coalition of
15Nurse Practitioners.

16(5) A representative of the Pennsylvania Chapter of the
17American College of Physicians.

18(6) A representative of the Pennsylvania Chapter of the
19American Academy of Pediatrics.

20(7) A representative of the Pennsylvania Medical
21Society.

22(8) A representative of the Pennsylvania Pharmacists
23Association.

24(9) A representative of the Hospital and Health System
25Association of Pennsylvania.

<-26(b) Organizational model.--The council shall recommend to

<-27(10) A representative of an approved patient-centered
28medical home.

29(11) A representative of the Mental Health Association
30of Pennsylvania.

1(12) A representative of the Pennsylvania Association of
2Community Health Centers.

3(13) A representative of the Coalition of Medical
4Assistance Managed Care Organizations.

5(c) Terms.--Each member of the council shall serve for a
6period of two years. Members may be reappointed by the
7secretary.

8(d) Meetings.--The department shall establish and coordinate
9meetings of the council. The secretary, or the secretary's
10designee, shall serve as chairperson of the council.

11(e) Expenses.--The members of the council shall not be paid,
12but shall be reimbursed for reasonable expenses.

13Section 4. Duties of the council.

14(a) Organizational model.--The council shall recommend to 
15the department an organizational model for the patient-centered 
16medical home system in this Commonwealth, including possible 
17Medicaid pilot projects. The organizational model shall provide 
18a strategy to coordinate health care services and provide for 
19monitoring and data collection on patient-centered medical 
20homes, for training and education to health care professionals 
21and families and for transition of children to the adult medical 
22care system. The organizational model may also include the use 
23of telemedicine resources and may provide for partnering with 
24pediatric and family practice residency programs to improve 
25access to preventive care for children. The organizational 
26structure shall also address the need to organize and provide 
27health care to increase accessibility for patients, including 
28using venues more accessible to patients and having hours of 
29operation that are conducive to the population served.

<-30(c) (b) Standards.--

1(1) The council shall recommend to the department
2standards and a process to certify patient-centered medical
3homes based on standards developed by a number of
4nongovernmental accrediting entities such as the National
5Committee for Quality Assurance and Accreditation Association
6for Ambulatory Health Care. The certification process and
7standards shall provide mechanisms to monitor performance and
8to evaluate, promote and improve the quality of health of,
9and health care delivered to, patients through a patient-
10centered medical home. The standards and process shall also
11include a mechanism for other ancillary service providers to
12become affiliated with a certified patient-centered medical
13home.

14(2) The council shall recommend to the department
15education and training standards for health care
16professionals participating in the patient-centered medical
17home system.

<-18(d) (c) Reimbursement methodology.--The council shall
19recommend to the department a reimbursement methodology and
20incentives for participation in the patient-centered medical
21home system sufficient to ensure that providers enter and remain
22participating in the system and to promote wellness, prevention,
23chronic care management, immunizations, health care management
24and the use of electronic health records and other pertinent
25concerns. In developing the recommendations, the council shall
26consider the feasibility of all of the following:

27(1) Reimbursement under the medical assistance program
28to promote wellness and prevention and to provide care
29coordination and chronic care management.

30(2) Increasing to Medicare levels the reimbursement for

1certain wellness and prevention services, chronic care
2management and immunizations.

3(3) Reducing the disparities between reimbursement for
4specialty services and primary care services.

5(4) Increased funding for efforts to transform medical
6practices into patient-centered medical homes, including the
7use of electronic health records.

8(5) Linking provider reimbursement rates to health care
9quality improvement measures established by the department.

10(6) Providing reimbursement for medication
11reconciliation and medication therapy management service.

<-12(d) Report.--The council shall provide an initial report of
13recommendations to the Governor, the Senate and the House of
14Representatives by December 31, 2014. Additional reports shall
15be provided on December 31 of even-numbered years so long as the
16council is in existence.

17Section 5. Effective date.

18This act shall take effect immediately.