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