State Legislation: PCMH and Advanced Primary Care

Tasks Insurance Commissioner with 1) forming a collaborative (the Colorado Primary Care Payment Reform Collaborative) to advise on increasing primary care spend 2) issue rules to set affordability standards, including PC spend targets

Establishes an Office of Health Care Strategy Office to develop an annual health care cost growth benchmark and primary care spending target. Develops and adopts health care quality benchmarks. Develops strategies, in consultation with stakeholders, to meet such benchmarks and targets developed. Enhances the transparency of provider entities. Monitors the development of accountable care organizations and  patient-centered medical homes in the state. Monitors the adoption of alternative payment methodologies in the state. Legislation enacted as a provision of 2022 state budget legislation.

This Act promotes the use of primary care by doing the following:

1. Creating a Primary Care Reform Collaborative under the Delaware Health Care Commission.

2. Requiring all health insurance providers to participate in the Delaware Health Care Claims Database.

3. Requiring individual, group, and State employee insurance plans to reimburse primary care physicians, certified nurse practitioners, physician assistants, and other front-line practitioners for chronic care management and primary care at no less than the physician Medicare rate for the next 3 years.

Hawaii requires Medicaid Managed Care Organizations to report on and increase the percentage of medical expenditures devoted to primary care.

This Executive Order creates the Idaho Healthcare Coalition (IHC). The IHC is charged with building upon the work of the previously established Idaho Medical Home Collaborative (Executive Order No. 2010-10) to facilitate and support the transformation of primary care practices to the PCMH model, develop regional collaboratives to support practices in transformation, and integrate PCMHs with the medical neighborhood that includes hospitals, behavioral health and other community support services.

This bill requires insurers to report primary care expenditures to the Maine Health Data Organization and for the Maine Quality Forum to use this data to report annually to the Department of Health and Human Services and the Legislature the percentage of total medical expenditures paid for primary care by commercial insurers, the MaineCare program, Medicare, the organization that administers health insurance for state employees and the Maine Education Association benefits trust respectively, the average of the percentage of total medical expenses paid for primary care across all organizations and the methods used by these organizations to pay for primary care. This bill also requires the Maine Quality Forum to conduct a study on best practices in health care spending reporting and submit its findings to the Department of Health and Human Services and the Joint Standing Committee on Health and Human Services.

Sets targets for investment in primary and behavioral healthcare. 

The law requires the State’s five major carriers of fully insured health benefit products (Aetna, CareFirst, CIGNA, Coventry, and UnitedHealthcare) to participate in the Maryland Multi-Payer Patient-Centered Medical Home Program (MMPP).

Establishes a Center for Health Information and Analysis (CHIA) charged with a range of duties, incuding analyzing health costs and utilization in the Massachusetts. On September 20, 2022, CHIA subsequently released the first report on primary care and behavioral health spending in Massachusetts.

This omnibus appropriations legislation would require a report on primary care spending and establish a Health Care Affordability Board that may consider establishing quality and primary care spending standards.

The Act included a provision that the Department of Social Services should create health improvement plans for all participants in MO HealthNet to include coordinated care plans and be enrolled in a health care home.

This law requires the insurance commissioner to rely on a council of stakeholders to create standards for the program, qualify health care providers and insurers to participate, and promote the program.

The legislation authorized the Nebraska Medical Home Pilot Program Act with the purpose of improving health care access and health outcomes for patients and containing costs in the Medicaid program. The act defined medical home for the state of Nebraska and authorized a two-year medical home pilot program.

The legislation employs a Medicaid Care Management (MCM) model for administering the New Hampshire Medicaid program, which began in December 2013.

In August 2011, Governor Christie signed this bill into law requiring the  Department of Medcial Assistance and Health Services (DMAHS) to establish a three year Medicaid Accountable Care Organization (ACO) demonstration project.

Establishes a primary care council, charged with analyzing primary care spend as a proportion of health care spending yearly, making recommendations for policy to recommend policies, regulations and legislation to increase access to primary care, improving the quality of primary care services and lowering the cost of primary care delivery while reducing overall health care costs;  Council must present a 5 year plan to the Secretary

The law gave the Commissioner of Health the authority to establish a Statewide PCMH program whereby providers who are recognized by the NCQA are eligible to receive additional payments for services provided to Medicaid FFS and managed care enrollees.

The legislation supports Community Care of North Carolina (CCNC) to continue serving as the anchor program in North Carolina for most of its health improvement and cost-containment efforts including Care Coordination for Children (CC4C), Dual-eligible initiative, Multi-payer Advanced Primary Care Practice Project (MAPCP), and Palliative Care Initiative, just to name a few.

SB 563 affirmed requirements for reporting of the percentage of health care expenses by each contracted entity on primary care services and that no later than the fourth year of a contract with the Medicaid program must devote at least 11% to primary care.

The legislation supported the patient-centered medical home (PCMH) and encouraged all health systems in Oklahoma to study and implement principles of the PCMH.

Requires coordinated care organization, Public Employees' Benefit Board and Oregon Educators Benefit Board to spend at least 12 percent of total medical expenditures on primary care by January 1, 2023. 

The legislation established the Patient Centered Primary Care Home (PCPCH) Program by the Office for Oregon Health Policy and Research. This law created a learning collaborative to assist practices in developing the infrastructure for PCPCH. The law also allowed for changes in payment for practices who provide care in medical homes including payment for interpretive services and rewards for improvements in health quality.

Requires coordinated care organization, Public Employees' Benefit Board and Oregon Educators Benefit Board to spend at least 12 percent of total medical expenditures on primary care by January 1, 2023. Requires Department of Consumer and Business Services to establish requirements for carrier to submit plan for increasing spending on primary care as percentage of total medical expenditures if carrier is spending less than 12 percent of total medical expenditures. Extends sunset on Primary Care Transformation Initiative.

The law establishes a Patient-Centered Medical Home Advisory Council, provides powers and duties of the council, and provides for the development of a plan to implement a statewide medical home model. 

Authorizes Insurance Commissioner to set minimum PC spending target for state-regulated insurers; engage in practice transformation activities, as part of promoting Affordability Standards

The legislation called for a study by the Health and Human Services Commission (HHSC) to submit a report to the Texas Legislature regarding the commission's work to ensure that Medicaid managed care organizations promote the development of patient-centered medical homes (PCMH) for recipients of medical assistance and provide payment incentives for clinicians that meet the requirements of a PCMH as required under Section 533.0029, Government Code.

Requires the Health Data Committee to annually issue a report on primary care spending within the state of Utah. 

The act expresses legislative intent that access to and payments for community health teams should begin at least six months before a medical practice is scheduled to be scored for Blueprint recognition, that the Blueprint director increase payments to medical homes because of new qualification requirements, and that all health plans, including the multistate plans required under the ACA, should participate in the Blueprint for Health.

The Act put Vermont on a path toward an integrated health care delivery system with a budget regulated by the new Green Mountain Care Board, universally available health insurance coverage that is not linked to employment and a single system for administration of claims and payments to providers.

This bill required the state Department of Health and Human Resources to contract with the Virginia Center for Health Innovation for actions necessary to facilitate and continue the work of the Virginia Task Force on Primary Care. The purpose of the task force is to enhance the financing, quality and delivery of primary care in the Commonwealth.

Charges the state’s Health Care Cost Transparency Board with measuring and reporting on primary care expenditures and progress toward increasing spending to 12% of total healthcare expenditures.

This bill creates the Primary Care Support Program within the Bureau of Public Health within the Department of Health and Human Resources. The program will provide technical and organizational assistance to community-based primary care services. It will also create and administer a Primary Care Grant Fund to grant money to federally qualified health centers and federally qualified health center look-alikes, and secure federal medical assistance percentage funding. Federally qualified health center look-alikes already receiving grant funding at the time this program is created will continue to receive grant funding annually. Upon approval by the secretary of the department, federally qualified health centers in need of immediate financial assistance may be granted funding annually. All funds designated to federally qualified health centers may be transferred to Medicaid for the purpose of securing federal medical assistance percentage funding. Additionally, the secretary may use certain portions of funds within this account for activities in support of rural and primary care.

This bill also creates a special revenue fund in the State Treasury to be known as the Primary Care Support Fund into which all appropriations, payments, and interest to the fund created herein shall be deposited, to be held and disbursed according to law.

The Primary Care Support Program will conduct and make available upon request an annual primary care report which shall consist of total West Virginia Medicaid primary care expenditures as a percentage of total West Virginia Medicaid expenditures.