Federally Qualified Health Centers; Patient-centered Health Care
Directs the Department of Health to establish a pilot project funding federally qualified health centers to provide services based on a patient-centered health care home model. (SB1094 HD1)
TWENTY-FIFTH LEGISLATURE, 2009
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO HEALTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that according to the American College of Physicians:
(1) The United States (U.S.) health care system is inadequately prepared to meet the current, let alone the future health care needs of an aging population;
(2) Health care costs are growing faster than the economy, leaving employers, government, and individuals straining under the financial burden; and
(3) Health care outcomes in the U.S. are poorer than in other industrialized nations that spend less on their health care systems.
The legislature also finds that the U.S. system of private and government-funded health insurance programs emphasize uncoordinated, episodic treatment for acute care, where a disproportionate amount of resources are paid for specialty or in-patient procedures, or emergency department visits compared to payments for primary and preventative care and care management.
The legislature further finds that a model sometimes termed "the patient-centered health care home" has resulted in better patient health and lower costs. This model is based on:
(1) Continuity in the relationship between the primary care provider and the patient;
(2) A whole-person/family orientation rather than a disease orientation;
(3) Integration and coordination of patient care;
(4) Processes that increase quality and reduce errors, including use of electronic health records, technology that improves communication, and the development and measurement of outcomes; and
(5) Timely access to care that also overcomes geographic, economic, and cultural barriers.
The legislature further finds that certain individuals and families require additional help to navigate the health care delivery system and to effectively make use of health care services. The services that provide this additional assistance are referred to as "enabling services."
The federally qualified health centers located in medically underserved areas or serving medically underserved populations have developed an appropriate model for a patient-centered health care home that can effectively deliver this additional assistance. The key standards for the model are community participation, cultural appropriateness, training and economic development, and enabling services.
The purpose of this Act is to direct payment of funds to federally qualified health centers to support these federally qualified health centers as patient-centered health care homes to improve patient care, reduce errors, and reduce the overall fiscal burden on the state's health care system.
SECTION 2. (a) The department of health shall establish a federally qualified health center pilot project for fiscal years 2010-2011 and 2011-2012.
(b) As used in this section, "enabling services" includes:
(1) Case management assessment: a non-medical assessment that includes the use of an acceptable instrument measuring socioeconomic, wellness, or other non-medical health status;
(2) Case management treatment facilitation: a meeting with a center-registered patient or the patient's household/or family member, where the patient's treatment plan is developed or facilitated by a case manager. The plan shall incorporate the services of multiple providers or health care disciplines;
(3) Case management referral: the facilitation of a visit for a registered patient of the center to a health care or social service provider;
(4) Financial counseling/eligibility assistance: the counseling of a patient presumed to have a family income of three hundred per cent of poverty level or less, which results in a completed application to a sliding fee scale or health insurance program including medicaid or medicare;
(5) Health education/supportive counseling-individual: the provision of health education or supportive services to individuals in which wellness, preventive disease management, or other improved health outcomes are sought through behavior change methodology;
(6) Health education/supportive counseling-group: the provision of health education or supportive services to groups of twelve or fewer individuals in which wellness, preventive disease management, or other improved health outcomes are sought through behavior change methodology;
(7) Interpretation: the provision of interpreter services by a third party (other than the primary care giver) intended to reduce barriers to a limited English-proficient patient, or a patient with documented limitations in writing or speaking skills sufficient to affect the outcome of a medical visit or procedure;
(8) Outreach: patient services that result in the conversion of a patient without a primary care provider to one who has been accepted into a provider's panel;
(9) Transportation: the provision of direct assistance to a patient by an employee or contractor of a primary care center to reduce barriers for a patient assigned to a primary care panel at a community health center; and
(10) Other: any other services provided by an employee or contractor of a primary care center that reduces access barriers for a patient assigned to a primary care panel at a community health center.
(c) The pilot project shall be funded through available sources as follows:
(1) Up to seventy-five per cent of funds shall be used to pay for uninsured services on a fee-for-service basis as follows:
(A) Level I: $95 per visit, during which the federally qualified health center provides a primary medical, behavioral health, or dental clinic visit, and all enabling services delineated above, as needed. In addition, the federally qualified health center will assist uninsured patients with public insurance applications, and track and report data regarding patients who remain uninsured;
(B) Level II: $100 per visit, during which all Level I services are provided. In addition, the federally qualified health center shall report on no less than one process or clinical outcome measure, as negotiated with the department of health;
(C) Level III: $105 per visit, during which all Level I services are provided. In addition, the federally qualified health center shall report on not less than six performance measures, as negotiated with the department of health;
(2) At least twenty-five per cent of funds, in addition to those funds not used for uninsured services on a fee-for-service basis, shall be used to strengthen and improve federally qualified health centers in terms of quality improvement, care management, health information, enhanced access systems, emergency preparedness, and facility improvement.
(d) The department of health shall submit a report of its findings and recommendations to the legislature no later than twenty days prior to the convening of the regular sessions of 2011, 2012, and 2013.
SECTION 3. This Act shall take effect upon its approval.