Current through Pa Acts 2024-53, 2024-56 through 2024-92
Section 7004 - Duties of the council(a)Organizational model.--The council shall recommend to the department an organizational model for the patient-centered medical home system in this Commonwealth, including possible Medicaid pilot projects. The organizational model shall provide a strategy to coordinate health care services and provide for monitoring and data collection on patient-centered medical homes, for training and education to health care professionals and families and for transition of children to the adult medical care system. The organizational model may also include the use of telemedicine resources and may provide for partnering with pediatric and family practice residency programs to improve access to preventive care for children. The organizational structure shall also address the need to organize and provide health care to increase accessibility for patients, including using venues more accessible to patients and having hours of operation that are conducive to the population served.(b)Standards.--(1) The council shall recommend to the department standards and a process to certify patient-centered medical homes based on standards developed by a number of nongovernmental accrediting entities . The certification process and standards shall provide mechanisms to monitor performance and to evaluate, promote and improve the quality of health of, and health care delivered to, patients through a patient- centered medical home. The standards and process shall also include a mechanism for other ancillary service providers to become affiliated with a certified patient-centered medical home.(2) The council shall recommend to the department education and training standards for health care professionals participating in the patient-centered medical home system.(c)Reimbursement methodology.--The council shall recommend to the department a reimbursement methodology and incentives for participation in the patient-centered medical home system sufficient to ensure that providers enter and remain participating in the system and to promote wellness, prevention, chronic care management, immunizations, health care management and the use of electronic health records and other pertinent concerns. In developing the recommendations, the council shall consider the feasibility of all of the following:(1) Reimbursement under the medical assistance program to promote wellness and prevention and to provide care coordination and chronic care management.(2) Increasing to Medicare levels the reimbursement for certain wellness and prevention services, chronic care management and immunizations.(3) Reducing the disparities between reimbursement for specialty services and primary care services.(4) Increased funding for efforts to transform medical practices into patient-centered medical homes, including the use of electronic health records.(5) Linking provider reimbursement rates to health care quality improvement measures established by the department.(6) Providing reimbursement for medication reconciliation and medication therapy management service.(d)Report.--The council shall provide an initial report of recommendations to the Governor, the Senate and the House of Representatives by December 31, 2015. Additional reports shall be provided on December 31 of odd-numbered years so long as the council is in existence.Added by P.L. TBD 2014 No. 198, § 4, eff. 10/31/2014.