Health Care Reform and the Patient Centered Medical Home

The enactment of the Patient Protection and Affordable Care Act and passage of the Health Care and Education Reconciliation Act mark an important moment for America and the Patient-Centered Primary Care Collaborative (PCPCC). The new law moves forward on several of the legislative objectives of the Collaborative. More work will be necessary in the administrative process as we follow through with the legislation.

The Chairmen and Members of the Legislative Committee wanted to take this opportunity to thank and congratulate all of those collaborative members whose combined efforts helped garner additional payment for primary care, additional training for primary care, and greater emphasis on the patient centered medical home model through legislative support for demonstrations. We have attached a summary of the provisions of the legislation in this area.

The collaborative has grown to a coalition of more than 700 employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, physicians and others who have joined together to develop and advance primary care and the patient centered medical home (PCMH).

The Legislative Committee will be working toward improving implementation of the legislative and programmatic goals through the administrative programs and looks forward to working with members of PCPCC on this effort.

 

Below are the major sections of the Health Care Reform bills relevant to the Patient Centered Primary Care Collaborative. These provisions were all supported by our principals and efforts.

 

From H.R. 3590 Patient Protection and Affordable Care Act

Title II Subtitle I

Sec. 2303 – Payment. See Amendment by Reconciliation Act below

Sec. 2703. State option to provide health homes for enrollees with chronic conditions. Provide States the option of enrolling Medicaid beneficiaries with chronic conditions into a health home. Health homes would be composed of a team of health professionals and would provide a comprehensive set of medical services, including care coordination.
 

Sec. 2706. Pediatric Accountable Care Organization demonstration project. Establishes a demonstration project that allows qualified pediatric providers to be recognized and receive payments as Accountable Care Organizations (ACO) under Medicaid. The pediatric ACO would be required to meet certain performance guidelines. Pediatric ACOs that met these guidelines and provided services at a lower cost would share in those savings.

 

Title III

Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation within CMS. Establishes within the Centers for Medicare and Medicaid Services (CMS) a Center for Medicare & Medicaid Innovation. The purpose of the Center will be to research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patients in each program. Dedicated funding is provided to allow for testing of models that require benefits not currently covered by Medicare. Successful models can be expanded nationally. Section 10306 adds payment reform models to the list of projects for the Center to consider, including medical homes.

 

Title V

Sec. 5301. Training in family medicine, general internal medicine, general pediatrics, and physician assistantship. Provides grants to develop and operate training programs, provide financial assistance to trainees and faculty, enhance faculty development in primary care and physician assistant programs, and to establish, maintain, and improve academic units in primary care. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home.

 

Sec. 5501. Expanding access to primary care services and general surgery services. Beginning in 2011, provides primary care practitioners, as well as general surgeons practicing in health professional shortage areas, with a 10 percent Medicare payment bonus for five years. Section 10501 removes the budget-neutrality adjustment that would have offset half of the cost of the primary care and general surgery bonuses.

Health Care and Education Reconciliation Act

 

Sec. 1202. Payments to primary care physicians. Requires that Medicaid payment rates to primary care physicians for furnishing primary care services be no less than 100% of Medicare payment rates in 2013 and 2014. Provides 100% federal funding for the additional costs to States of meeting this requirement.

 

 

Information is from summaries by Senate Democratic Policy Committee