House File 2474 - Introduced
HOUSE FILE
BY UPMEYER
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to chronic care management.
2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
3 TLSB 6235YH 82
4 pf/rj/5
PAG LIN
1 1 Section 1. NEW SECTION. 135.158 DEFINITIONS.
1 2 For the purpose of this division, unless the context
1 3 otherwise requires:
1 4 1. "Chronic care" means health services provided by a
1 5 health care provider for an established clinical condition
1 6 that is expected to last a year or more and that requires
1 7 ongoing clinical management to attempt to restore the
1 8 individual to highest function, minimize the negative effects
1 9 of the chronic condition, and prevent complications related to
1 10 the chronic condition.
1 11 2. "Chronic care information system" means approved
1 12 information technology to enhance the development and
1 13 communication of information to be used in providing chronic
1 14 care, including clinical, social, and economic outcomes of
1 15 chronic care.
1 16 3. "Chronic care infrastructure" means the state's plan
1 17 for chronic care infrastructure, prevention of chronic
1 18 conditions, and a chronic care management program, and
1 19 includes an integrated approach to patient self=management,
1 20 community development, health care system and professional
1 21 practice changes, and information technology initiatives.
1 22 4. "Chronic care management" means a system of coordinated
1 23 health care interventions and communications for individuals
1 24 with chronic conditions, including significant patient
1 25 self=care efforts, systemic supports for the physician and
1 26 patient relationship, and a chronic care plan emphasizing
1 27 prevention of complications utilizing evidence=based practice
1 28 guidelines, patient empowerment strategies, and evaluation of
1 29 clinical, humanistic, and economic outcomes on an ongoing
1 30 basis with the goal of improving overall health.
1 31 5. "Chronic care plan" means a plan of care between an
1 32 individual and the individual's principal health care provider
1 33 that emphasizes prevention of complications through patient
1 34 empowerment including but not limited to providing incentives
1 35 to engage patients in the patient's own care; and clinical,
2 1 social, or other interventions designed to minimize the
2 2 negative effects of the condition.
2 3 6. "Chronic care resources" means health care providers,
2 4 advocacy groups, health departments, schools of public health
2 5 and medicine, health plans and others with expertise in public
2 6 health, health care delivery, health care financing, and
2 7 health care research.
2 8 7. "Chronic condition" means an established clinical
2 9 condition that is expected to last a year or more and that
2 10 requires ongoing clinical management.
2 11 8. "Department" means the department of public health.
2 12 9. "Director" means the director of public health.
2 13 10. "Eligible individual" means a resident of the state
2 14 who has been diagnosed with a chronic condition or is at an
2 15 elevated risk for a chronic condition and who is a recipient
2 16 of medical assistance or hawk=i program benefits, is a member
2 17 of the expansion population pursuant to chapter 249J, or is an
2 18 inmate of a correctional institution in the state.
2 19 11. "Health care provider" means an individual,
2 20 partnership, corporation, facility, or institution licensed or
2 21 certified or authorized by law to provide health care services
2 22 within the state.
2 23 12. "Health risk assessment" means screening by a health
2 24 care provider for the purpose of assessing an individual's
2 25 health, including tests or physical examinations and a survey
2 26 or other tool used to gather information about an individual's
2 27 health, medical history, and health risk factors during a
2 28 health screening.
2 29 13. "Prevention and chronic care partnership" means a
2 30 regionally based consortium of health care providers and
2 31 chronic care resources that promote the health of community
2 32 residents and prevention of chronic conditions, develop and
2 33 implement arrangements for delivering chronic care, develop
2 34 significant patient self=care efforts, and provide systemic
2 35 supports for the physician=patient relationship.
3 1 14. "State initiative for prevention and chronic care
3 2 management" or "state initiative" means the state's plan for
3 3 developing a chronic care infrastructure for prevention and
3 4 chronic care management, including coordinating the efforts of
3 5 health care providers and chronic care resources to promote
3 6 the health of residents and the prevention and management of
3 7 chronic conditions, developing and implementing arrangements
3 8 for delivering prevention services and chronic care
3 9 management, developing significant patient self=care efforts,
3 10 providing systemic support for the health care
3 11 provider=patient relationship and options for channeling
3 12 chronic care resources and support to health care providers,
3 13 providing for community outreach and education efforts, and
3 14 coordinating information technology initiatives.
3 15 Sec. 2. NEW SECTION. 135.159 PREVENTION AND CHRONIC CARE
3 16 MANAGEMENT INITIATIVE == ADVISORY COUNCIL.
3 17 1. The director, in collaboration with the prevention and
3 18 chronic care management advisory council, shall develop a
3 19 state initiative for prevention and chronic care management.
3 20 2. The director may accept grants and donations, and shall
3 21 apply for any federal, state, or private grants available to
3 22 fund the initiative. Any grants or donations received shall
3 23 be placed in a separate fund in the state treasury and used
3 24 exclusively for the initiative.
3 25 3. The director shall convene an advisory council to
3 26 provide technical assistance to the director in developing a
3 27 state initiative that integrates evidence=based prevention and
3 28 chronic care management strategies into the public and private
3 29 health care systems. The advisory council, at a minimum,
3 30 shall include all of the following members:
3 31 a. The director of human services, or the director's
3 32 designee.
3 33 b. The director of the department of elder affairs, or the
3 34 director's designee.
3 35 c. The commissioner of insurance, or the commissioner's
4 1 designee.
4 2 d. A representative of the Iowa medical society.
4 3 e. A representative of the Iowa hospital association.
4 4 f. A representative of health insurers.
4 5 g. A medical social worker or home care professional.
4 6 h. A patient advocate.
4 7 i. A primary care physician.
4 8 j. A pharmacist.
4 9 k. A specialist in public health and epidemiology.
4 10 l. An expert in health outcomes research.
4 11 m. A representative of an entity that is taking a leading
4 12 role in health information technology.
4 13 4. The advisory council shall elicit input from a variety
4 14 of health care providers, health care provider organizations,
4 15 community and nonprofit groups, insurers, consumers,
4 16 businesses, school districts, and state and local governments
4 17 in developing the advisory council's recommendations.
4 18 5. The advisory council shall submit initial
4 19 recommendations to the director for the prevention and chronic
4 20 care management initiative no later than January 1, 2009. The
4 21 recommendations shall address all of the following:
4 22 a. The recommended organizational structure, including the
4 23 recommended size and geographic boundaries of the regions of
4 24 the state to serve as territories, for the prevention and
4 25 chronic care partnerships. The advisory council shall also
4 26 prioritize one of these regions to be used as an initial pilot
4 27 for a prevention and chronic care partnership.
4 28 b. A process for identifying leading health care providers
4 29 and existing prevention and chronic care resources within the
4 30 prevention and chronic care partnership regions identified and
4 31 for consulting with these providers and resources.
4 32 c. A prioritization of the chronic conditions for which
4 33 prevention and chronic care management services shall be
4 34 provided, taking into consideration the prevalence of specific
4 35 chronic conditions and the factors that may lead to the
5 1 development of chronic conditions, the fiscal impact to state
5 2 health care programs of providing care for the chronic
5 3 conditions of eligible individuals, the availability of
5 4 workable, evidence=based approaches to chronic care, and
5 5 public input into the selection process. The recommendation
5 6 shall also include a timeline for inclusion of specific
5 7 chronic conditions in the initiative.
5 8 d. A method to involve health care providers in
5 9 identifying eligible patients, which includes but is not
5 10 limited to the use of a uniform health risk assessment.
5 11 e. The methods for increasing communication between health
5 12 care providers and patients, including patient education,
5 13 self=management, and follow=up plans.
5 14 f. The educational, wellness, and clinical management
5 15 protocols and tools to be used by health care providers,
5 16 including management guideline materials for health care.
5 17 g. The use and development of process and outcome
5 18 measures, aligned to the greatest extent possible with
5 19 existing measures, to provide performance feedback for health
5 20 care providers and information on the quality of care,
5 21 including patient satisfaction and health status outcomes.
5 22 h. Payment methodologies to align reimbursements and
5 23 create financial incentives and rewards for health care
5 24 providers to utilize prevention services, establish management
5 25 systems for chronic conditions, improve health outcomes, and
5 26 improve the quality of care, including case management fees,
5 27 payment for technical support and data entry associated with
5 28 patient registries, and the cost of staff coordination within
5 29 a medical practice.
5 30 i. Methods to involve public and private groups, health
5 31 care providers, insurers, third=party administrators,
5 32 associations, community and consumer groups, and other local
5 33 entities to facilitate and sustain the initiative.
5 34 j. Alignment of any information technology needs with
5 35 other health care information technology initiatives.
6 1 k. Methods to involve appropriate health resources and
6 2 public health and outcomes researchers to develop and
6 3 implement a sound basis for collecting data and evaluating the
6 4 clinical, social, and economic impact of the initiative,
6 5 including a determination of the impact on expenditures and
6 6 prevalence and control of chronic conditions.
6 7 l. Elements of a marketing campaign that provides for
6 8 public outreach and consumer education in promoting prevention
6 9 and chronic care management strategies among health care
6 10 providers, health insurers, and the public.
6 11 m. A method to periodically determine the percentage of
6 12 health care providers who are participating, the success of
6 13 the empowerment=of=patients approach, and any results of
6 14 health outcomes of the patients participating.
6 15 6. The director of human services shall obtain any federal
6 16 waivers or state plan amendments necessary to implement the
6 17 prevention and chronic care management initiative within the
6 18 medical assistance, hawk=i, and IowaCare populations.
6 19 7. Following submission of the initial recommendations by
6 20 January 1, 2009, the director shall select one or more regions
6 21 for deploying and evaluating a prevention and chronic care
6 22 partnership pilot project. Following deployment of the
6 23 initial pilot project, the director shall work with the
6 24 department of human services, insurers, health care provider
6 25 organizations, and consumers in implementing the initiative
6 26 beyond the population of eligible individuals as an integral
6 27 part of the health care delivery system in the state. The
6 28 advisory council shall continue to review and make
6 29 recommendations to the director regarding improvements in the
6 30 initiative.
6 31 8. Each prevention and chronic care partnership shall do
6 32 all of the following:
6 33 a. Select, based on the recommendations of the advisory
6 34 council, the chronic conditions for which chronic care and
6 35 prevention services will be provided within the region after
7 1 considering the prevalence of the chronic condition in the
7 2 region and factors that may lead to the development of chronic
7 3 conditions, the fiscal impact to the state of providing care
7 4 for the chronic condition for the eligible population, the
7 5 availability of workable, evidence=based approaches to chronic
7 6 care for the chronic condition, and any public input received.
7 7 b. Determine how to implement the prevention and chronic
7 8 care services on a regional basis in a manner that
7 9 participating health care providers and chronic care resources
7 10 support.
7 11 c. Develop a mechanism for health care providers and
7 12 chronic care resources to participate in the partnership.
7 13 d. Identify and disseminate evidence=based information to
7 14 participating health care providers and chronic care
7 15 resources.
7 16 e. Assist in outreach programs to address chronic
7 17 conditions.
7 18 f. Recommend mechanisms to provide incentives for
7 19 participation by health care providers and chronic care
7 20 resources.
7 21 g. Recommend and evaluate health information options to
7 22 enhance the accuracy and efficiency of communications
7 23 necessary to the delivery of chronic care.
7 24 h. Collect data as recommended by the advisory council and
7 25 director to evaluate the clinical, social, and economic impact
7 26 of the partnership.
7 27 EXPLANATION
7 28 This bill relates to prevention and chronic care
7 29 management. The bill directs the director of public health,
7 30 in collaboration with the prevention and chronic care
7 31 management advisory council created in the bill, to develop a
7 32 state initiative for prevention and chronic care management.
7 33 The bill provides that the director may accept grants and
7 34 donations, and shall apply for any federal, state, or private
7 35 grants available to fund the initiative. Grants or donations
8 1 received are to be placed in a separate fund in the state
8 2 treasury and used exclusively for the initiative.
8 3 The bill directs the director of public health to convene
8 4 an advisory council to provide technical assistance to the
8 5 director in developing a state initiative that integrates
8 6 evidence=based prevention and chronic care management
8 7 strategies into the public and private health care systems.
8 8 The bill specifies the membership of the advisory council and
8 9 directs the advisory council to elicit input from health care
8 10 providers, health care provider organizations, community and
8 11 nonprofit groups, insurers, consumers, businesses, school
8 12 districts, and state and local governments in making its
8 13 recommendations. The bill provides that the advisory council
8 14 shall submit initial recommendations to the director for the
8 15 prevention and chronic care management initiative no later
8 16 than January 1, 2009. The recommendations are to address:
8 17 the organizational structure for the prevention and chronic
8 18 care partnerships which are regionally based prevention and
8 19 chronic care delivery systems, and an initial partnership to
8 20 be used as a pilot; a process for identifying leading health
8 21 care providers and existing prevention and chronic care
8 22 resources within partnership regions identified and for
8 23 consulting with these providers and resources; a
8 24 prioritization of the chronic conditions for which prevention
8 25 and chronic care management services shall be provided and a
8 26 timeline for inclusion of specific chronic conditions in the
8 27 initiative; a method to involve health care providers in
8 28 identifying eligible patients, which includes the use of a
8 29 uniform health risk assessment; the methods for increasing
8 30 communication between health care providers and patients;
8 31 protocols and tools to be used by health care providers; the
8 32 use and development of process and outcome measures to provide
8 33 performance feedback for health care providers and information
8 34 on the quality of care; payment methodologies to align
8 35 reimbursements and create financial incentives and rewards for
9 1 health care providers to utilize prevention services,
9 2 establish management systems for chronic conditions, improve
9 3 health outcomes, and improve the quality of care; methods to
9 4 involve public and private groups, health care providers,
9 5 insurers, third=party administrators, associations, community
9 6 and consumer groups, and other local entities to facilitate
9 7 and sustain the initiative; alignment of any information
9 8 technology needs with other health care information technology
9 9 initiatives; methods to involve appropriate health resources
9 10 and public health and outcomes researchers to develop and
9 11 implement a sound basis for collecting data and evaluating the
9 12 clinical, social, and economic impact of the initiative;
9 13 elements of a marketing campaign that provides for public
9 14 outreach and consumer education in promoting prevention and
9 15 chronic care management strategies among health care
9 16 providers, health insurers, and the public; and a method to
9 17 periodically determine the percentage of health care providers
9 18 who are participating, the success of the empowerment of
9 19 patients approach, and any results of health outcomes of the
9 20 patients participating.
9 21 The bill directs the director of human services to obtain
9 22 any federal waivers or state plan amendments necessary to
9 23 implement the prevention and chronic care management
9 24 initiative within the medical assistance, hawk=i, and IowaCare
9 25 populations.
9 26 The bill directs the director of public health, following
9 27 the submission of the initial recommendations by the advisory
9 28 council, to select one or more regions for deploying and
9 29 evaluating prevention and chronic care partnerships pilot
9 30 projects. Following deployment of the initial pilot project,
9 31 the director shall work with the department of human services,
9 32 insurers, health care provider organizations, and consumers in
9 33 implementing the initiative beyond the population of eligible
9 34 individuals as an integral part of the health care delivery
9 35 system in the state. The advisory council is directed to
10 1 continue to review and make recommendations to the director
10 2 regarding improvements in the initiative.
10 3 The bill also specifies requirements for each prevention
10 4 and chronic care partnership.
10 5 LSB 6235YH 82
10 6 pf/rj/5