135.158 - MEDICAL HOME PURPOSES -- CHARACTERISTICS.

        135.158  MEDICAL HOME PURPOSES -- CHARACTERISTICS.
         1.  The purposes of a medical home are the following:
         a.  To reduce disparities in health care access, delivery, and
      health care outcomes.
         b.  To improve quality of health care and lower health care
      costs, thereby creating savings to allow more Iowans to have health
      care coverage and to provide for the sustainability of the health
      care system.
         c.  To provide a tangible method to document if each Iowan has
      access to health care.
         2.  A medical home has all of the following characteristics:
         a.  A personal provider.  Each patient has an ongoing
      relationship with a personal provider trained to provide first
      contact and continuous and comprehensive care.
         b.  A provider-directed medical practice.  The personal
      provider leads a team of individuals at the practice level who
      collectively take responsibility for the ongoing health care of
      patients.
         c.  Whole person orientation.  The personal provider is
      responsible for providing for all of a patient's health care needs or
      taking responsibility for appropriately arranging health care by
      other qualified health care professionals.  This responsibility
      includes health care at all stages of life including provision of
      acute care, chronic care, preventive services, and end-of-life care.

         d.  Coordination and integration of care.  Care is coordinated
      and integrated across all elements of the complex health care system
      and the patient's community.  Care is facilitated by registries,
      information technology, health information exchanges, and other means
      to assure that patients receive the indicated care when and where
      they need and want the care in a culturally and linguistically
      appropriate manner.
         e.  Quality and safety.  The following are quality and safety
      components of the medical home:
         (1)  Provider-directed medical practices advocate for their
      patients to support the attainment of optimal, patient-centered
      outcomes that are defined by a care planning process driven by a
      compassionate, robust partnership between providers, the patient, and
      the patient's family.
         (2)  Evidence-based medicine and clinical decision-support tools
      guide decision making.
         (3)  Providers in the medical practice accept accountability for
      continuous quality improvement through voluntary engagement in
      performance measurement and improvement.
         (4)  Patients actively participate in decision making and feedback
      is sought to ensure that the patients' expectations are being met.
         (5)  Information technology is utilized appropriately to support
      optimal patient care, performance measurement, patient education, and
      enhanced communication.
         (6)  Practices participate in a voluntary recognition process
      conducted by an appropriate nongovernmental entity to demonstrate
      that the practice has the capabilities to provide patient-centered
      services consistent with the medical home model.
         (7)  Patients and families participate in quality improvement
      activities at the practice level.
         f.  Enhanced access to health care.  Enhanced access to health
      care is available through systems such as open scheduling, expanded
      hours, and new options for communication between the patient, the
      patient's personal provider, and practice staff.
         g.  Payment.  The payment system appropriately recognizes the
      added value provided to patients who have a patient-centered medical
      home.  The payment structure framework of the medical home provides
      all of the following:
         (1)  Reflects the value of provider and nonprovider staff and
      patient-centered care management work that is in addition to the
      face-to-face visit.
         (2)  Pays for services associated with coordination of health care
      both within a given practice and between consultants, ancillary
      providers, and community resources.
         (3)  Supports adoption and use of health information technology
      for quality improvement.
         (4)  Supports provision of enhanced communication access such as
      secure electronic mail and telephone consultation.
         (5)  Recognizes the value of provider work associated with remote
      monitoring of clinical data using technology.
         (6)  Allows for separate fee-for-service payments for face-to-face
      visits.  Payments for health care management services that are in
      addition to the face-to-face visit do not result in a reduction in
      the payments for face-to-face visits.
         (7)  Recognizes case mix differences in the patient population
      being treated within the practice.
         (8)  Allows providers to share in savings from reduced
      hospitalizations associated with provider-guided health care
      management in the office setting.
         (9)  Allows for additional payments for achieving measurable and
      continuous quality improvements.  
         Section History: Recent Form
         2008 Acts, ch 1188, §45
         Referred to in § 135.157