1Establishing the Patient-Centered Medical Home Advisory Council;
2providing powers and duties of the council, the Department of
3Public Welfare Human Services<-; and providing for development
4of a plan to implement 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

1Council established by this act.

2"Department." The Department of <-Public Welfare Human 
3Services of the Commonwealth.

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 team approach to
9providing health care that:

10(1) is physician-led, 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 or led by a physician assistant 
14practicing under the supervision and direction of a physician 
15as required by the act of December 20, 1985 (P.L.457, 
16No.112), known as the Medical Practice Act of 1985;

17(2) originates in a primary care setting;

18(3) fosters a partnership among the patient, the
<-19personal patient's provider and other health care
20professionals and, where appropriate, the patient's family;

21(4) utilizes the partnership to access all medical-
22health-related services and nonmedical-health-related
23services needed by the patient to achieve maximum health
24potential; and

25(5) maintains a centralized, comprehensive record of all
26health related services to promote continuity of care.

27"Primary care." Health care that emphasizes a patient's
28general health needs and utilizes collaboration with other
29health care professionals and consultation or referral as
30appropriate to meet the needs identified.

1"Primary care physician." Any of the following who provide
2primary care and meet certification standards:

3(1) a physician who is a family or general practitioner;

4(2) a pediatrician;

5(3) an internist;

6(4) an obstetrician; or

7(5) a gynecologist.

8"Secretary." The Secretary of <-Public Welfare Human Services
9of the Commonwealth.

10"Telemedicine." The use of telecommunication and information
11technology in order to provide clinical health care at a
12distance.

13Section 3. Patient-Centered Medical Home Advisory Council.

14(a) Establishment.--The Patient-Centered Medical Home
15Advisory Council is established. The council shall advise the
16department on how Pennsylvania's Medicaid program can increase
17the quality of care while containing costs through the following
18Patient-Centered Medical Home model approaches:

19(1) Coordinate and provide access to evidence-based
20health care services, emphasizing convenient, comprehensive
21primary care and including preventive, screening and well-
22child health services.

23(2) Provide access to appropriate specialty care, mental
24health services, inpatient services and any evidence-based
25alternative therapies.

26(3) Provide quality-driven and cost-effective health
27care.

28(4) Provide access to medication and medication therapy
29management services, <-where appropriate in accordance with 
30section 935(c) of the Patient Protection and Affordable Care
 

1Act (Public Law 111-148, 42 U.S.C. § 299b-35(c)).

2(5) Promote strong and effective medical management,
3including, but not limited to, planning treatment strategies,
4monitoring health outcomes and resource use, sharing
5information and organizing care to avoid duplication of
6services, including the use of electronic medical records. In
7sharing information, the protection of the privacy of
8individuals and of the <-individual's individuals' information
9shall be priorities. In addition to any and all other Federal
10and State provisions for the confidentiality of health care
11information, any information-sharing required by a medical
12home system shall be subject to written consent of the
13patient.

14(6) Provide comprehensive care management to patients to
15align and assist with treatment strategies, health outcomes,
16resource utilization and organization of care and address
17determinants of health impeding goals of care.

18(7) Emphasize patient and provider accountability.

19(8) Prioritize access to the continuum of health care
20services in the most appropriate setting and in the most
21cost-effective manner.

22(9) Establish a baseline for medical home goals and
23establish performance measures that indicate a patient has an
24established and effective medical home. These goals and
25performance measures may include, but need not be limited to,
26childhood immunization rates, well-child care utilization
27rates, care management for chronic illnesses and emergency
28room utilization.

29(b) Composition.--The secretary shall appoint the members of 
30the council, in consultation with the President pro tempore of
 

1the Senate, the Majority Leader of the Senate, the Minority 
2Leader of the Senate, the Speaker of the House of 
3Representatives, the Majority Leader of the House of 
4Representatives and the Minority Leader of the House of 
5Representatives, <-who shall consist of the following:

6(1) The secretary, or a designee.

7(2) A representative of the Pennsylvania Academy of
8Family Physicians.

9(3) A representative of the Pennsylvania section of the
10American Congress of Obstetricians and Gynecologists.

11(4) A representative of the Pennsylvania Coalition of
12Nurse Practitioners.

13(5) A representative of the Pennsylvania Chapter of the
14American College of Physicians.

15(6) A representative of the Pennsylvania Chapter of the
16American Academy of Pediatrics.

17(7) A representative of the Pennsylvania Medical
18Society.

19(8) A representative of the Pennsylvania Pharmacists
20Association.

21(9) A representative of the Hospital and Health System
22Association of Pennsylvania.

23(10) A representative of an approved patient-centered
24medical home.

25(11) A representative of the Mental Health Association
26of Pennsylvania.

27(12) A representative of the Pennsylvania Association of
28Community Health Centers.

29(13) A representative of a managed care organization 
30licensed to do business in this Commonwealth.

1(14) A representative of the Pennsylvania Society of
2Physician Assistants.

<-3which shall consist of the secretary or a designee and
4individuals representing the following interests:

5(1) Family physicians.

6(2) Obstetricians and gynecologists.

7(3) Nurse practitioners.

8(4) Internists.

9(5) Pediatricians.

10(6) Pharmacists.

11(7) Hospital and health systems.

12(8) Patient-centered medical homes.

13(9) Mental health care providers.

14(10) Community health centers.

15(11) Managed care organizations licensed to do business
16in the Commonwealth.

17(12) Physician assistants.

18(c) Professional organizations representing the professions
19indicated in subsection (b) may submit names to the secretary
20for the purpose of being appointed to the council.

<-21(c) (d) Terms.--Each member of the council shall serve for a
22period of two years. Members may be reappointed by the
23secretary.

<-24(d) (e) Meetings.--The department shall establish and
25coordinate meetings of the council. The secretary, or the
26secretary's designee, shall serve as chairperson of the council.

<-27(e) (f) Expenses.--The members of the council shall not be
28paid, but shall be reimbursed for reasonable expenses.

29Section 4. Duties of the council.

30(a) Organizational model.--The council shall recommend to
 

1the department an organizational model for the patient-centered 
2medical home system in this Commonwealth, including possible 
3Medicaid pilot projects. The organizational model shall provide 
4a strategy to coordinate health care services and provide for 
5monitoring and data collection on patient-centered medical 
6homes, for training and education to health care professionals 
7and families and for transition of children to the adult medical 
8care system. The organizational model may also include the use 
9of telemedicine resources and may provide for partnering with 
10pediatric and family practice residency programs to improve 
11access to preventive care for children. The organizational 
12structure shall also address the need to organize and provide 
13health care to increase accessibility for patients, including 
14using venues more accessible to patients and having hours of 
15operation that are conducive to the population served.

16(b) Standards.--

17(1) The council shall recommend to the department
18standards and a process to certify patient-centered medical
19homes based on standards developed by a number of
20nongovernmental accrediting entities <-such as the National 
21Committee for Quality Assurance and Accreditation Association 
22for Ambulatory Health Care. The certification process and
23standards shall provide mechanisms to monitor performance and
24to evaluate, promote and improve the quality of health of,
25and health care delivered to, patients through a patient-
26centered medical home. The standards and process shall also
27include a mechanism for other ancillary service providers to
28become affiliated with a certified patient-centered medical
29home.

30(2) The council shall recommend to the department

1education and training standards for health care
2professionals participating in the patient-centered medical
3home system.

4(c) Reimbursement methodology.--The council shall recommend
5to the department a reimbursement methodology and incentives for
6participation in the patient-centered medical home system
7sufficient to ensure that providers enter and remain
8participating in the system and to promote wellness, prevention,
9chronic care management, immunizations, health care management
10and the use of electronic health records and other pertinent
11concerns. In developing the recommendations, the council shall
12consider the feasibility of all of the following:

13(1) Reimbursement under the medical assistance program
14to promote wellness and prevention and to provide care
15coordination and chronic care management.

16(2) Increasing to Medicare levels the reimbursement for
17certain wellness and prevention services, chronic care
18management and immunizations.

19(3) Reducing the disparities between reimbursement for
20specialty services and primary care services.

21(4) Increased funding for efforts to transform medical
22practices into patient-centered medical homes, including the
23use of electronic health records.

24(5) Linking provider reimbursement rates to health care
25quality improvement measures established by the department.

26(6) Providing reimbursement for medication
27reconciliation and medication therapy management service.

28(d) Report.--The council shall provide an initial report of
29recommendations to the Governor, the Senate and the House of
30Representatives by December 31, <-2014 2015. Additional reports

1shall be provided on December 31 of <-even-numbered odd-numbered
2years so long as the council is in existence.

<-3Section 5. Expiration.

4This act shall expire June 30, 2020.

5Section <-5 6. Effective date.

6This act shall take effect immediately.