135.159 - MEDICAL HOME SYSTEM -- ADVISORY COUNCIL -- DEVELOPMENT AND IMPLEMENTATION.

        135.159  MEDICAL HOME SYSTEM -- ADVISORY COUNCIL --
      DEVELOPMENT AND IMPLEMENTATION.
         1.  The department shall administer the medical home system.  The
      department shall adopt rules pursuant to chapter 17A necessary to
      administer the medical home system.
         2. a.  The department shall establish an advisory council
      which shall include but is not limited to all of the following
      members, selected by their respective organizations, and any other
      members the department determines necessary to assist in the
      department's duties at various stages of development of the medical
      home system:
         (1)  The director of human services, or the director's designee.
         (2)  The commissioner of insurance, or the commissioner's
      designee.
         (3)  A representative of the federation of Iowa insurers.
         (4)  A representative of the Iowa dental association.
         (5)  A representative of the Iowa nurses association.
         (6)  A physician and an osteopathic physician licensed pursuant to
      chapter 148 who are family physicians and members of the Iowa academy
      of family physicians.
         (7)  A health care consumer.
         (8)  A representative of the Iowa collaborative safety net
      provider network established pursuant to section 135.153.
         (9)  A representative of the governor's developmental disabilities
      council.
         (10)  A representative of the Iowa chapter of the American academy
      of pediatrics.
         (11)  A representative of the child and family policy center.
         (12)  A representative of the Iowa pharmacy association.
         (13)  A representative of the Iowa chiropractic society.
         (14)  A representative of the university of Iowa college of public
      health.
         b.  Public members of the advisory council shall receive
      reimbursement for actual expenses incurred while serving in their
      official capacity only if they are not eligible for reimbursement by
      the organization that they represent.
         3.  The department shall develop a plan for implementation of a
      statewide medical home system.  The department, in collaboration with
      parents, schools, communities, health plans, and providers, shall
      endeavor to increase healthy outcomes for children and adults by
      linking the children and adults with a medical home, identifying
      health improvement goals for children and adults, and linking
      reimbursement strategies to increasing healthy outcomes for children
      and adults.  The plan shall provide that the medical home system
      shall do all of the following:
         a.  Coordinate and provide access to evidence-based health
      care services, emphasizing convenient, comprehensive primary care and
      including preventive, screening, and well-child health services.
         b.  Provide access to appropriate specialty care and inpatient
      services.
         c.  Provide quality-driven and cost-effective health care.
         d.  Provide access to pharmacist-delivered medication
      reconciliation and medication therapy management services, where
      appropriate.
         e.  Promote strong and effective medical management including
      but not limited to planning treatment strategies, monitoring health
      outcomes and resource use, sharing information, and organizing care
      to avoid duplication of service.  The plan shall provide that in
      sharing information, the priority shall be the protection of the
      privacy of individuals and the security and confidentiality of the
      individual's information.  Any sharing of information required by the
      medical home system shall comply and be consistent with all existing
      state and federal laws and regulations relating to the
      confidentiality of health care information and shall be subject to
      written consent of the patient.
         f.  Emphasize patient and provider accountability.
         g.  Prioritize local access to the continuum of health care
      services in the most appropriate setting.
         h.  Establish a baseline for medical home goals and establish
      performance measures that indicate a child or adult has an
      established and effective medical home.  For children, these goals
      and performance measures may include but are not limited to childhood
      immunization rates, well-child care utilization rates, care
      management for children with chronic illnesses, emergency room
      utilization, and oral health service utilization.
         i.  For children, coordinate with and integrate guidelines,
      data, and information from existing newborn and child health programs
      and entities, including but not limited to the healthy opportunities
      for parents to experience success--healthy families Iowa program, the
      community empowerment program, the center for congenital and
      inherited disorders screening and health care programs, standards of
      care for pediatric health guidelines, the office of multicultural
      health established in section 135.12, the oral health bureau
      established in section 135.15, and other similar programs and
      services.
         4.  The department shall develop an organizational structure for
      the medical home system in this state.  The organizational structure
      plan shall integrate existing resources, provide a strategy to
      coordinate health care services, provide for monitoring and data
      collection on medical homes, provide for training and education to
      health care professionals and families, and provide for transition of
      children to the adult medical care system.  The organizational
      structure may be based on collaborative teams of stakeholders
      throughout the state such as local public health agencies, the
      collaborative safety net provider network established in section
      135.153, or a combination of statewide organizations.  Care
      coordination may be provided through regional offices or through
      individual provider practices.  The organizational structure 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.
         5.  The department shall adopt standards and a process to certify
      medical homes based on the national committee for quality assurance
      standards.  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 medical home.  The mechanism shall require
      participating providers to monitor clinical progress and performance
      in meeting applicable standards and to provide information in a form
      and manner specified by the department.  The evaluation mechanism
      shall be developed with input from consumers, providers, and payers.
      At a minimum the evaluation shall determine any increased quality in
      health care provided and any decrease in cost resulting from the
      medical home system compared with other health care delivery systems.
      The standards and process shall also include a mechanism for other
      ancillary service providers to become affiliated with a certified
      medical home.
         6.  The department shall adopt education and training standards
      for health care professionals participating in the medical home
      system.
         7.  The department shall provide for system simplification through
      the use of universal referral forms, internet-based tools for
      providers, and a central medical home internet site for providers.
         8.  The department shall recommend a reimbursement methodology and
      incentives for participation in the medical home system to ensure
      that providers enter and remain participating in the system.  In
      developing the recommendations for incentives, the department shall
      consider, at a minimum, providing incentives to promote wellness,
      prevention, chronic care management, immunizations, health care
      management, and the use of electronic health records.  In developing
      the recommendations for the reimbursement system, the department
      shall analyze, at a minimum, the feasibility of all of the following:

         a.  Reimbursement under the medical assistance program to
      promote wellness and prevention, provide care coordination, and
      provide chronic care management.
         b.  Increasing reimbursement to Medicare levels for certain
      wellness and prevention services, chronic care management, and
      immunizations.
         c.  Providing reimbursement for primary care services by
      addressing the disparities between reimbursement for specialty
      services and primary care services.
         d.  Increased funding for efforts to transform medical
      practices into certified medical homes, including emphasizing the
      implementation of the use of electronic health records.
         e.  Targeted reimbursement to providers linked to health care
      quality improvement measures established by the department.
         f.  Reimbursement for specified ancillary support services
      such as transportation for medical appointments and other such
      services.
         g.  Providing reimbursement for medication reconciliation and
      medication therapy management service, where appropriate.
         9.  The department shall coordinate the requirements and
      activities of the medical home system with the requirements and
      activities of the dental home for children as described in section
      249J.14, subsection 7, and shall recommend financial incentives for
      dentists and nondental providers to promote oral health care
      coordination through preventive dental intervention, early
      identification of oral disease risk, health care coordination and
      data tracking, treatment, chronic care management, education and
      training, parental guidance, and oral health promotions for children.

         10.  The department shall integrate the recommendations and
      policies developed by the prevention and chronic care management
      advisory council into the medical home system.
         11.  Implementation phases.
         a.  Initial implementation shall require participation in the
      medical home system of children who are recipients of full benefits
      under the medical assistance program.  The department shall work with
      the department of human services and shall recommend to the general
      assembly a reimbursement methodology to compensate providers
      participating under the medical assistance program for participation
      in the medical home system.
         b.  The department shall work with the department of human
      services to expand the medical home system to adults who are
      recipients of full benefits under the medical assistance program and
      the expansion population under the IowaCare program.  The department
      shall work with the centers for Medicare and Medicaid services of the
      United States department of health and human services to allow
      Medicare recipients to utilize the medical home system.
         c.  The department shall work with the department of
      administrative services to allow state employees to utilize the
      medical home system.
         d.  The department shall work with insurers and self-insured
      companies, if requested, to make the medical home system available to
      individuals with private health care coverage.
         12.  The department shall provide oversight for all certified
      medical homes.  The department shall review the progress of the
      medical home system and recommend improvements to the system, as
      necessary.
         13.  The department shall annually evaluate the medical home
      system and make recommendations to the governor and the general
      assembly regarding improvements to and continuation of the system.
         14.  Recommendations and other activities resulting from the
      duties authorized for the department under this section shall require
      approval by the board prior to any subsequent action or
      implementation.  
         Section History: Recent Form
         2008 Acts, ch 1188, §46; 2009 Acts, ch 41, §44; 2009 Acts, ch 133,
      §34
         Referred to in § 136.3