Section 135.159. Medical home system — patient-centered health advisory council — development and implementation.

  1.  The department shall administer the medical home system. The department shall collaborate with the department of human services in administering medical homes under the medical assistance program. The department shall adopt rules pursuant to chapter 17A necessary to administer the medical home system, and shall collaborate with the department of human services in adopting rules for medical homes under the medical assistance program.

  2.  a.  The department shall establish a patient-centered health 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 Iowa 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 patient-centered health 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 early childhood Iowa initiative, the center for congenital and inherited disorders screening and health care programs, standards of care for pediatric health guidelines, the office of minority and 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 a dental home. The department 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. Additionally, the department shall establish requirements for the medical home system to provide linkages to accessible dental homes for adults and older individuals.

  10.  The department shall integrate the recommendations and policies developed pursuant to section 135.161, Code 2011, into the medical home system and shall incorporate the development and implementation of the state initiative for prevention and chronic care management as developed pursuant to section 135.161, Code 2011, into the duties of the patient-centered health advisory council beginning January 1, 2012.

  11.  a.  The department shall collaborate with the department of human services to make medical homes accessible to the greatest extent possible to all of the following no later than January 1, 2015:

  (1)  Children who are recipients of full benefits under the medical assistance program.

  (2)  Adults who are recipients of benefits under the medical assistance program pursuant to section 249A.3, subsection 1.

  (3)  Medicare and dually eligible Medicare and medical assistance program recipients, to the extent approved by the centers for Medicare and Medicaid services of the United States department of health and human services.

  b.  The department shall work with the department of administrative services to allow state employees to utilize the medical home system.

  c.  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.

  d.  The department shall assist the department of human services in developing a reimbursement methodology to compensate providers participating under the medical assistance program as a medical home.

  e.  Any integrated care model implemented on or after July 1, 2013, that delivers health care to medical assistance program recipients shall incorporate medical homes as its foundation. The medical home shall act as the catalyst in any such integrated care model to ensure compliance with the purposes, characteristics, and implementation plan requirements specified in section 135.158 and this section, including an emphasis on whole-person orientation and coordination and integration of both clinical services and nonclinical community and social supports that address social determinants of health.

  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.

2008 Acts, ch 1188, §46

; 2009 Acts, ch 41, §44

; 2009 Acts, ch 133, §34

; 2010 Acts, ch 1031, §292

; 2010 Acts, ch 1141, §23

; 2011 Acts, ch 25, §16

; 2011 Acts, ch 129, §78, 82

; 2012 Acts, ch 1023, §25

; 2013 Acts, ch 138, §176, 187

; 2015 Acts, ch 137, §38 – 41, 162, 163

2015 amendments take effect July 2, 2015, and apply retroactively to July 1, 2015; 2015 Acts, ch 137, §162, 163

Code editor directive applied

Subsection 2, paragraph a, unnumbered paragraph 1 amended

Subsection 2, paragraph b amended

Subsection 10 amended