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

5The General Assembly of the Commonwealth of Pennsylvania
6hereby enacts as follows:

7Section 1. Short title.

8This act shall be known and may be cited as the Patient-
9Centered Medical Home Advisory Council Act.

10Section 2. Definitions.

11The following words and phrases when used in this act shall
12have the meanings given to them in this section unless the
13context clearly indicates otherwise:

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

17"Council." The Patient-Centered Medical Home Advisory
18Council 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 team approach to
8providing health care that:

9(1) is physician-led <-or,<- led by a nurse practitioner 
10practicing under a collaborative agreement as required by the 
11act of May 22, 1951 (P.L.317, No.69), known as The 
12Professional Nursing Law<-. <-or led by a physician assistant 
13practicing under the supervision and direction of a physician 
14as required by the act of December 20, 1985 (P.L.457, 
15No.112), known as the Medical Practice Act of 1985;

16(2) originates in a primary care setting;

17(3) fosters a partnership among the patient, the
18personal provider and other health care professionals and,
19where appropriate, the patient's family;

20(4) utilizes the partnership to access all medical-
21health-related services and nonmedical-health-related
22services needed by the patient to achieve maximum health
23potential; and

24(5) maintains a centralized, comprehensive record of all
25health related services to promote continuity of care.

26"Primary care." Health care that emphasizes a patient's
27general health needs and utilizes collaboration with other
28health care professionals and consultation or referral as
29appropriate to meet the needs identified.

30"Primary care physician." Any of the following who provide

1primary care and meet certification standards:

2(1) a physician who is a family or general practitioner;

3(2) a pediatrician;

4(3) an internist;

5(4) an obstetrician; or

6(5) a gynecologist.

7"Secretary." The Secretary of Public Welfare of the
8Commonwealth.

9"Telemedicine." The use of telecommunication and information
10technology in order to provide clinical health care at a
11distance.

12Section 3. Patient-Centered Medical Home Advisory Council.

13(a) Establishment.--The Patient-Centered Medical Home
14Advisory Council is established. The council shall advise the
15department on how Pennsylvania's Medicaid program can increase
16the quality of care while containing costs through the following
17Patient-Centered Medical Home model approaches:

18(1) Coordinate and provide access to evidence-based
19health care services, emphasizing convenient, comprehensive
20primary care and including preventive, screening and well-
21child health services.

22(2) Provide access to appropriate specialty care, mental
23health services, inpatient services and any evidence-based
24alternative therapies.

25(3) Provide quality-driven and cost-effective health
26care.

27(4) Provide access to medication and medication therapy
28management services, where appropriate.

29(5) Promote strong and effective medical management,
30including, but not limited to, planning treatment strategies,

1monitoring health outcomes and resource use, sharing
2information and organizing care to avoid duplication of
3services, including the use of electronic medical records. In
4sharing information, the protection of the privacy of
5individuals and of the individual's information shall be
6priorities. In addition to any and all other Federal and
7State provisions for the confidentiality of health care
8information, any information-sharing required by a medical
9home system shall be subject to written consent of the
10patient.

11(6) Provide comprehensive care management to patients to
12align and assist with treatment strategies, health outcomes,
13resource utilization and organization of care and address
14determinants of health impeding goals of care.

15(7) Emphasize patient and provider accountability.

16(8) Prioritize access to the continuum of health care
17services in the most appropriate setting and in the most
18cost-effective manner.

19(9) Establish a baseline for medical home goals and
20establish performance measures that indicate a patient has an
21established and effective medical home. These goals and
22performance measures may include, but need not be limited to,
23childhood immunization rates, well-child care utilization
24rates, care management for chronic illnesses and emergency
25room utilization.

26(b) Composition.--The secretary shall appoint the members of 
27the council, in consultation with the President pro tempore of 
28the Senate, the Majority Leader of the Senate, the Minority 
29Leader of the Senate, the Speaker of the House of 
30Representatives, the Majority Leader of the House of
 

1Representatives and the Minority Leader of the House of 
2Representatives, who shall consist of the following:

3(1) The secretary, or a designee.

4(2) A representative of the Pennsylvania Academy of
5Family Physicians.

6(3) A representative of the Pennsylvania section of the
7American Congress of Obstetricians and Gynecologists.

8(4) A representative of the Pennsylvania Coalition of
9Nurse Practitioners.

10(5) A representative of the Pennsylvania Chapter of the
11American College of Physicians.

12(6) A representative of the Pennsylvania Chapter of the
13American Academy of Pediatrics.

14(7) A representative of the Pennsylvania Medical
15Society.

16(8) A representative of the Pennsylvania Pharmacists
17Association.

18(9) A representative of the Hospital and Health System
19Association of Pennsylvania.

20(10) A representative of an approved patient-centered
21medical home.

22(11) A representative of the Mental Health Association
23of Pennsylvania.

24(12) A representative of the Pennsylvania Association of
25Community Health Centers.

26(13) A representative of <-the Coalition of Medical 
27Assistance Managed Care Organizations <-a managed care 
28organization licensed to do business in this Commonwealth.

29(14) A representative of the Pennsylvania Society of
30Physician Assistants.

1(c) Terms.--Each member of the council shall serve for a
2period of two years. Members may be reappointed by the
3secretary.

4(d) Meetings.--The department shall establish and coordinate
5meetings of the council. The secretary, or the secretary's
6designee, shall serve as chairperson of the council.

7(e) Expenses.--The members of the council shall not be paid,
8but shall be reimbursed for reasonable expenses.

9Section 4. Duties of the council.

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

26(b) Standards.--

27(1) The council shall recommend to the department
28standards and a process to certify patient-centered medical
29homes based on standards developed by a number of
30nongovernmental accrediting entities such as the National

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

10(2) The council shall recommend to the department
11education and training standards for health care
12professionals participating in the patient-centered medical
13home system.

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

23(1) Reimbursement under the medical assistance program
24to promote wellness and prevention and to provide care
25coordination and chronic care management.

26(2) Increasing to Medicare levels the reimbursement for
27certain wellness and prevention services, chronic care
28management and immunizations.

29(3) Reducing the disparities between reimbursement for
30specialty services and primary care services.

1(4) Increased funding for efforts to transform medical
2practices into patient-centered medical homes, including the
3use of electronic health records.

4(5) Linking provider reimbursement rates to health care
5quality improvement measures established by the department.

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

8(d) Report.--The council shall provide an initial report of
9recommendations to the Governor, the Senate and the House of
10Representatives by December 31, 2014. Additional reports shall
11be provided on December 31 of even-numbered years so long as the
12council is in existence.

13Section 5. Effective date.

14This act shall take effect immediately.