SENATE, No. 682

SECTION 1. Chapter 118H of the general laws as inserted by chapter 58 of the acts of 2006, is hereby amended in section 1, by inserting after the definition for “fund,” the following new definition: -

 “medical home,” as used in this chapter, means a primary care practice that utilizes a comprehensive approach to providing patient-centered care that is accessible, continuous, and coordinated so that the relationship between the provider and patient is directed at maintaining a healthy lifestyle with preventive and ongoing health services and is respectful of, and responsive to, individual patient preference, needs, and values.

SECTION 2.  Chapter 118H of the general laws as inserted by chapter 58 of the acts of 2006, is hereby further amended by adding after section 6, the following new section:  -   

Section 7.  Commonwealth Care Medical Home Demonstration Program

     The board is hereby authorized to establish a commonwealth care medical home demonstration program for the purpose of redesigning the health care delivery system to provide targeted, accessible, continuous, and coordinated, family-centered care to high need populations including, but not limited to those with multiple chronic illnesses that require regular monitoring, advising, or treatment.

     Under the demonstration program, case management fees would be paid to personal physicians and incentive payments would be paid to physicians participating in practices that provide “medical home” services.  Medical homes are physician practices in charge of targeting eligible individuals for program participation.  They are responsible for: (1) providing safe and secure technology to promote patient access to personal health information; (2) developing a health assessment tool for the targeted individuals; and (3) providing training for personnel involved in the coordination of care.

     The program shall operate for three years in urban, rural, and underserved areas in up to ten communities and would include physician practices with fewer than three full-time equivalent physicians, as well as larger practices, particularly in rural and underserved areas.

     Personal physicians who provide first contact and continuous care for their patients must be board certified.  Such personal physicians must also have a staff and resources to manage the comprehensive and coordinated care of each of their patients.  Participating physicians may be specialists or sub-specialists for patients requiring ongoing care for specific conditions, multiple chronic conditions such as severe asthma, complex diabetes, cardiovascular disease, and rheumatologic disorder, or for those with a prolonged illness.

     Personal physicians must perform or provide for the performance of: (1) advocates for and providing ongoing support, oversight, and guidance to implement a plan of care; that provides an integrated, coherent, cross-discipline plan for ongoing medical care developed in partnership with patients and including all other physicians furnishing care to the patient involved and other appropriate medical personnel or agencies such as home health agencies; (2) uses evidence-based medicine and clinical decision support tools to guide decision-making at the point-of-care based on patient-specific factors; (3) uses health information technology that may include remote monitoring and patient registries; and (4) encourages patients to engage in management of their own health through education and support systems.

     The board is hereby authorized to establish a system of supplemental payments for care management to personal physicians through the establishment of a care management fee, and shall establish within commonwealth care a care management fee code and a value for these payments.

     The board is hereby further authorized to establish a system of supplemental payment for a medical home to physician group practices through the establishment of a medical home fee, and shall establish within commonwealth care a medical home fee code and a value for these payments

     The board shall provide a yearly program evaluation and submit said report to the senate and house chairs of the joint committee on health care financing and the chairs of the senate and house committees on ways and means.

SECTION 2.  This act shall take effect on July 1, 2008.