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