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Patient Centered Primary Care Home Program

Wednesday, April 12, 2017


ORS 413.259 & 413.260, 414.655

     
      413.259 Patient centered primary care home program. (1) There is established in the Oregon Health Authority the patient centered primary care home program. Through this program, the authority shall:
      (a) Define core attributes of the patient centered primary care home to promote a reasonable level of consistency of services provided by patient centered primary care homes in this state. In defining core attributes related to ensuring that care is coordinated, the authority shall focus on determining whether these patient centered primary care homes offer comprehensive primary care, including prevention and disease management services;
      (b) Establish a simple and uniform process to identify patient centered primary care homes that meet the core attributes defined by the authority under paragraph (a) of this subsection;
      (c) Develop uniform quality measures that build from nationally accepted measures and allow for standard measurement of patient centered primary care home performance;
      (d) Develop uniform quality measures for acute care hospital and ambulatory services that align with the patient centered primary care home quality measures developed under paragraph (c) of this subsection; and
      (e) Develop policies that encourage the retention of, and the growth in the numbers of, primary care providers.
      (2)(a) The Director of the Oregon Health Authority shall appoint an advisory committee to advise the authority in carrying out subsection (1) of this section.
      (b) The director shall appoint to the advisory committee 15 individuals who represent a diverse constituency and are knowledgeable about patient centered primary care home delivery systems and health care quality.
      (c) Members of the advisory committee are not entitled to compensation, but may be reimbursed for actual and necessary travel and other expenses incurred by them in the performance of their official duties in the manner and amounts provided for in ORS 292.495. Claims for expenses shall be paid out of funds appropriated to the authority for the purposes of the advisory committee.
      (d) The advisory committee shall use public input to guide policy development.
      (3) The authority will also establish, as part of the patient centered primary care home program, a learning collaborative in which state agencies, private health insurance carriers, third party administrators and patient centered primary care homes can:
      (a) Share information about quality improvement;
      (b) Share best practices that increase access to culturally competent and linguistically appropriate care;
      (c) Share best practices that increase the adoption and use of the latest techniques in effective and cost-effective patient centered care;
      (d) Coordinate efforts to develop and test methods to align financial incentives to support patient centered primary care homes;
      (e) Share best practices for maximizing the utilization of patient centered primary care homes by individuals enrolled in medical assistance programs, including culturally specific and targeted outreach and direct assistance with applications to adults and children of racial, ethnic and language minority communities and other underserved populations;
      (f) Coordinate efforts to conduct research on patient centered primary care homes and evaluate strategies to implement the patient centered primary care home to improve health status and quality and reduce overall health care costs; and
      (g) Share best practices for maximizing integration to ensure that patients have access to comprehensive primary care, including preventative and disease management services.
      (4) The Legislative Assembly declares that collaboration among public payers, private health carriers, third party purchasers and providers to identify appropriate reimbursement methods to align incentives in support of patient centered primary care homes is in the best interest of the public. The Legislative Assembly therefore declares its intent to exempt from state antitrust laws, and to provide immunity from federal antitrust laws, the collaborative and associated payment reforms designed and implemented under subsection (3) of this section that might otherwise be constrained by such laws. The Legislative Assembly does not authorize any person or entity to engage in activities or to conspire to engage in activities that would constitute per se violations of state or federal antitrust laws including, but not limited to, agreements among competing health care providers or health carriers as to the prices of specific levels of reimbursement for health care services.
      (5) The authority may contract with a public or private entity to facilitate the work of the learning collaborative described in subsection (3) of this section and may apply for, receive and accept grants, gifts, payments and other funds and advances, appropriations, properties and services from the United States, the State of Oregon or any governmental body or agency or from any other public or private corporation or person for the purpose of establishing and maintaining the collaborative. [Formerly 442.210] 

      413.260 Patient centered primary care home health care delivery model. (1) The Oregon Health Authority, in collaboration with health insurers and purchasers of health plans including the Public Employees' Benefit Board, the Oregon Educators Benefit Board and other members of the patient centered primary care home learning collaborative and the patient centered primary care home program advisory committee, shall:

      (a) Develop, test and evaluate strategies that reward enrollees in publicly funded health plans for:

      (A) Receiving care through patient centered primary care homes that meet the core attributes established in ORS 413.259;

      (B) Seeking preventative and wellness services;

      (C) Practicing healthy behaviors; and

      (D) Effectively managing chronic diseases.

      (b) Develop, test and evaluate community-based strategies that utilize community health workers to enhance the culturally competent and linguistically appropriate health services provided by patient centered primary care homes in underserved communities.

      (2) The authority shall focus on patients with chronic health conditions in developing strategies under this section.

      (3) The authority, in collaboration with the Public Employees' Benefit Board and the Oregon Educators Benefit Board, shall establish uniform standards for contracts with health benefit plans providing coverage to public employees to promote the provision of patient centered primary care homes, especially for enrollees with chronic medical conditions, that are consistent with the uniform quality measures established under ORS 413.259 (1)(c).

      (4) The standards established under subsection (3) of this section may direct health benefit plans to provide incentives to primary care providers who serve vulnerable populations to partner with health-focused community-based organizations to provide culturally specific health promotion and disease management services. [2009 c.595 §1165; 2015 c.318 §21; 2015 c.798 §6]

      414.655 Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations. (1) The Oregon Health Authority shall establish standards for the utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations.

      (2) Each coordinated care organization shall implement, to the maximum extent feasible, patient centered primary care homes and behavioral health homes, including developing capacity for services in settings that are accessible to families, diverse communities and underserved populations, including the provision of integrated health care. The organization shall require its other health and services providers to communicate and coordinate care with the patient centered primary care home or behavioral health home in a timely manner using electronic health information technology.

      (3) Standards established by the authority for the utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations may require the use of federally qualified health centers, rural health clinics, school-based health clinics and other safety net providers that qualify as patient centered primary care homes or behavioral health homes to ensure the continued critical role of those providers in meeting the needs of underserved populations.

      (4) In order to promote the full integration of behavioral health and physical health services in primary care, behavioral health care and urgent care settings, providers in patient centered primary care homes and behavioral health homes may use billing codes applicable to the behavioral health and physical health services that are provided.

      (5) Each coordinated care organization shall report to the authority on uniform quality measures prescribed by the authority by rule for patient centered primary care homes and behavioral health homes.

      (6) Patient centered primary care homes and behavioral health homes must participate in the learning collaborative described in ORS 413.259 (3). [2011 c.602 §6; 2015 c.798 §5]

      Note: Sections 2 and 17, chapter 798, Oregon Laws 2015, provide:

      Sec. 2. The Oregon Health Authority shall prescribe by rule standards for achieving the integration of behavioral health services and physical health services in patient centered primary care homes and behavioral health homes. [2015 c.798 §2]

      Sec. 17. Section 2 of this 2015 Act is repealed on June 30, 2017. [2015 c.798 §17]
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