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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1303 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1303

To authorize the Secretary of Health and Human Services to establish a 
              women's medical home demonstration project.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             June 18, 2009

 Mr. Menendez introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
To authorize the Secretary of Health and Human Services to establish a 
              women's medical home demonstration project.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Women's Medical Home Demonstration 
Act''.

SEC. 2. WOMEN'S MEDICAL HOME DEMONSTRATION PROJECT.

    (a) Definitions.--In this Act:
            (1) Advisory council.--The term ``Advisory Council'' means 
        the advisory council established under subsection (c).
            (2) CHIP.--The term ``CHIP'' means the State Children's 
        Health Insurance Program established under title XXI of the 
        Social Security Act (42 U.S.C. 1397aa et seq.).
            (3) Eligible individuals.--
                    (A) In general.--The term ``eligible individual'' 
                means a woman who is receiving assistance under 
                Medicaid or CHIP.
                    (B) Priority for certain women.--In enrolling 
                eligible individuals in a demonstration project 
                conducted under this section, the eligible entity 
                conducting the project shall give special consideration 
                to enrolling eligible individuals receiving services 
                described in any of clauses (i) through (ix) of 
                paragraph (8)(G).
            (4) Eligible entity.--The term ``eligible entity'' means a 
        State, an entity or organization receiving payments under 
        Medicaid or CHIP, an entity or organization that is receiving 
        assistance under section 330 of the Public Health Service Act 
        (42 U.S.C. 254b), a federally qualified health center (as 
        defined in subsection (l)(2)(C) of section 1905 of the Social 
        Security Act (42 U.S.C. 1396d), a rural health clinic (as 
        defined in subsection (l)(1) of such section), or an entity 
        that receives assistance under title X or XX of the Public 
        Health Service Act (42 U.S.C. 300 et seq., 300z et seq.), that 
        submits an approved application to the Secretary to conduct a 
        demonstration project under this section.
            (5) Medicaid.--The term ``Medicaid'' means the Federal and 
        State program for medical assistance established under title 
        XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
            (6) Principal women's health provider.--The term 
        ``principal women's health provider'' means:
                    (A) A physician (as defined in section 1861(r)(1) 
                of the Social Security Act (42 U.S.C. 1395x(r)(1)) who 
                meets the following requirements:
                            (i) The physician is a board certified 
                        physician who specializes in women's health 
                        issues, such as obstetrics and gynecology, and 
                        who provides continuous and comprehensive care 
                        for individuals under the physician's care.
                            (ii) The physician has the staff and 
                        resources to manage the comprehensive and 
                        coordinated health care of each such 
                        individual.
                            (iii) The physician practices in a practice 
                        or health center recognized to be a women's 
                        medical home.
                            (iv) Such other requirements as are defined 
                        by the Secretary in consultation with the 
                        Advisory Council.
                    (B) An advance practice nurse, including a 
                certified nurse-midwife (CNM) or certified midwife (CM) 
                certified by the American Midwifery Certification 
                Board, or physician assistant, who meets the following 
                requirements:
                            (i) The advance practice nurse or physician 
                        assistant specializes in women's health issues, 
                        such as obstetrics and gynecology, and provides 
                        continuous and comprehensive care for patients.
                            (ii) The advance practice nurse or 
                        physician assistant has the staff and resources 
                        to manage the comprehensive and coordinated 
                        health care of each such individual.
                            (iii) The advance practice nurse or 
                        physician assistant practices in a practice or 
                        health center recognized to be a women's 
                        medical home.
                            (iv) Such other requirements as are defined 
                        by the Secretary in consultation with the 
                        Advisory Council.
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (8) Women's medical home.--The term ``women's medical 
        home'' means a physician-led practice, or advanced practice 
        nurse-directed practice in those States in which independent 
        practice is included in the scope of practice of licensed 
        advanced practice nurses, that uses practice innovations to 
        improve the management and coordination of women's health care 
        and that meets the following standards:
                    (A) The practice, health center, or clinic is able 
                to provide or coordinate a continuum of care for women 
                across their life spans, including wellness care, 
                preconception care, prenatal care, family planning, 
                medical care, mental and behavioral health care, 
                screening, and followup care for health needs later in 
                life.
                    (B) The practice, health center, or clinic applies 
                standards for access to care and communication with 
                eligible individuals participating in the demonstration 
                project established under this section, including 
                direct and ongoing access to the principal women's 
                health provider who accepts responsibility for 
                providing continuous care, including coordination for 
                comprehensive health care to the whole person, in 
                collaboration with teams of other health professionals, 
                including other nurses, primary care and specialist 
                physicians, and mental health professionals, as needed 
                and appropriate. Care is patient and family centered, 
                culturally and linguistically appropriate, structured 
                to ensure women receive complete and accurate health 
                information to make their own health care decisions, 
                and structured to assure confidentiality so that teens 
                and women may seek needed care in a timely way.
                    (C) The practice, health center, or clinic has 
                readily accessible, clinically useful information on 
                eligible individuals participating in the demonstration 
                project established under this section that enables the 
                practice to treat such individuals comprehensively and 
                systematically.
                    (D) The practice, health center, or clinic 
                maintains continuous relationships with eligible 
                individuals participating in the demonstration project 
                established under this section by implementing 
                evidence-based guidelines and applying them to the 
                identified needs of such individuals over time and with 
                the intensity needed by such individuals.
                    (E) The practice, health center, or clinic provides 
                ongoing assistance and encouragement in patient 
                management. The practice--
                            (i) collaborates with eligible individuals 
                        participating in the demonstration project 
                        established under this section to pursue their 
                        goals for optimal achievable health; and
                            (ii) assesses patient-specific barriers to 
                        communication and conducts activities to 
                        support patient self-management.
                    (F) The practice, health center, or clinic has in 
                place the resources and processes necessary to achieve 
                improvements in the management and coordination of care 
                for eligible individuals participating in the 
                demonstration project established under this section, 
                including--
                            (i) providing training programs for 
                        personnel involved in the coordination of care; 
                        and
                            (ii) utilizing information technology to 
                        support optimal patient care, performance 
                        measurement, patient education, and enhanced 
                        communication.
                    (G) The practice, health center, or clinic is able 
                to provide 1 or more of the following services:
                            (i) Treats women who are deemed at risk for 
                        premature birth.
                            (ii) Provides services related to 
                        prevention of cervical cancer by immunization, 
                        periodic cervical cytology and early treatment 
                        of precursor lesions.
                            (iii) Provides and coordinates care for 
                        women with breast or gynecologic cancer.
                            (iv) Provides and coordinates services for 
                        women experiencing menopause, perimenopause and 
                        related issues such as osteoporosis, fracture 
                        prevention, and mental health concerns.
                            (v) Provides family planning care.
                            (vi) Provides and coordinates postpartum 
                        health services, including care for women 
                        experiencing perinatal depression.
                            (vii) Provides and coordinates care for 
                        women who are members of a minority population 
                        that experiences health disparities.
                            (viii) Provides and coordinates care for 
                        chronic conditions.
                            (ix) Any other services specified by the 
                        Secretary, in consultation with the Advisory 
                        Council.
                    (H) The practice, health center, or clinic monitors 
                its clinical process and performance (including process 
                and outcome measures) and provides information in a 
                form and manner specified by the Secretary and Advisory 
                Council with respect to such process and performance.
                    (I) The practice, health center, or clinic meets 
                the requirements imposed on a covered entity for 
                purposes of applying part C of title XI of the Public 
                Health Service Act (42 U.S.C. 300b-1 et seq.) and all 
                regulatory provisions promulgated there under, 
                including regulations (relating to privacy) adopted 
                pursuant to the authority of the Secretary under 
                section 264(c) of the Health Insurance Portability and 
                Accountability Act of 1996 (42 U.S.C. 1320d-2 note).
    (b) Establishment.--
            (1) In general.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall establish a women's 
        medical home demonstration project (in this section referred to 
        as the ``project'') to--
                    (A) guide the redesign of the health care delivery 
                system for women to provide targeted, accessible, 
                continuous, coordinated, confidential, and 
                comprehensive care to eligible individuals with a 
                particular focus on--
                            (i) coordinating and improving care of 
                        women who are deemed at risk for premature 
                        birth;
                            (ii) preventing cervical cancer by 
                        immunization, periodic cervical cytology and 
                        early treatment of precursor lesions;
                            (iii) coordinating and improving care of 
                        women with breast or gynecologic cancer;
                            (iv) coordinating and improving care for 
                        women experiencing menopause, perimenopause and 
                        related issues such as osteoporosis, fracture 
                        prevention and mental health concerns;
                            (v) providing and improving care in family 
                        planning services;
                            (vi) providing and coordinating care for 
                        women postpartum, including those deemed to be 
                        at risk for perinatal depression;
                            (vii) providing, coordinating, and 
                        improving care of women who are members of a 
                        minority population that experiences health 
                        disparities;
                            (viii) providing and coordinating care for 
                        individuals with chronic conditions; and
                            (ix) providing any other services specified 
                        by the Secretary, in consultation with the 
                        Advisory Council.
                    (B) provide principal care management payments, 
                performance-based bonus payments, incentive payments 
                for additional operations costs, and any other 
                services, specified by the Secretary in consultation 
                with the Advisory Council, to providers participating 
                in a women's medical home under the project.
            (2) Nature and scope of project.--
                    (A) Duration; scope.--The project shall be 
                conducted for a 3-year period and shall include a 
                nationally representative sample of physicians, advance 
                practice nurses, and physician assistants who 
                specialize in women's health and who serve urban, 
                rural, and underserved areas in a total of no more than 
                8 States.
                    (B) Encouraging participation of small physician 
                practices.--The project shall be designed to include 
                the participation of physicians in practices with fewer 
                than 4 full-time equivalent physicians, as well as 
                physicians in larger practices, particularly in rural 
                and underserved areas.
            (3) Project goals.--The project shall be designed in order 
        to determine whether and to what extent women's medical homes 
        accomplish the following, with special consideration given to 
        the services and outcomes described in clauses (i) through (ix) 
        of paragraph (1)(A):
                    (A) Increase--
                            (i) cost efficiencies of health care 
                        delivery;
                            (ii) access to appropriate health care 
                        services;
                            (iii) patient satisfaction;
                            (iv) communication among providers, 
                        hospitals, and other health care providers; and
                            (v) the quality of health care services 
                        provided, as based on measures of quality the 
                        Secretary, in consultation with the Advisory 
                        Council, has specified.
                    (B) Decrease--
                            (i) inappropriate emergency room 
                        utilization;
                            (ii) avoidable hospitalizations;
                            (iii) duplication of health care services 
                        provided; and
                            (iv) health disparities.
                    (C) Provide appropriate referrals to 
                multidisciplinary services.
            (4) Services performed.--A principal provider operating 
        within a women's medical home shall perform or provide for the 
        performance of services--
                    (A) described in subsection (a)(8)(G); and
                    (B) any additional services specified by Secretary 
                in consultation with the Advisory Council.
            (5) Eligible individual and eligible entity 
        participation.--
                    (A) Eligible individuals.--The Secretary shall 
                establish a process under which--
                            (i) an eligible individual may elect to 
                        participate in a women's medical home under the 
                        project; and
                            (ii) no cost sharing shall be imposed with 
                        respect to any service required under paragraph 
                        (4) to be provided to the individual under the 
                        project.
                    (B) Assurance of participation of eligible entities 
                that are not participating providers or are in states 
                with managed care.--The Secretary shall establish a 
                process to ensure that eligible entities that are not 
                participating providers under the State Medicaid or 
                CHIP program, or, in the case of a State that contracts 
                with a private entity to manage parts of the State 
                Medicaid or CHIP program, do not participate with that 
                entity, are able to participate in the project.
            (6) Standard setting process.--The Secretary shall, in 
        consultation with the Advisory Council--
                    (A) specify standards for practices, health 
                centers, and clinics to qualify for certification as 
                women's medical homes, including standards described in 
                subsection (a)(8)(B);
                    (B) specify characteristics of principal women's 
                health providers consistent with subsection (a)(6);
                    (C) specify services a principal physician, 
                principal advance practice nurse, or principal 
                physician assistant operating within a women's medical 
                home shall perform or provide for the performance of;
                    (D) develop a women's medical home reimbursement 
                methodology which shall include at a minimum--
                            (i) recognition of the value of physician 
                        and clinical staff work associated with patient 
                        care that falls outside the face-to-face visit, 
                        such as the time and effort spent on educating 
                        family caregivers and arranging appropriate 
                        followup services with other health care 
                        professionals, such as nurse educators;
                            (ii) services associated with coordination 
                        of care both within a given practice and 
                        between consultants, ancillary providers, and 
                        community resources;
                            (iii) recognition of expenses that the 
                        women's medical home practices will incur to 
                        acquire and utilize health information 
                        technology, such as clinical decision support 
                        tools, patient registries, or electronic 
                        medical records;
                            (iv) reimbursement for separately 
                        identifiable e-mail and telephonic 
                        consultations, either as separately billable 
                        services or as part of a global management fee;
                            (v) recognition of the value of provider 
                        work associated with remote monitoring of 
                        clinical data using technology;
                            (vi) allowance for separate fee-for-service 
                        payments for face-to-face visits;
                            (vii) recognition of case mix differences 
                        in the patient population being treated within 
                        the practice;
                            (viii) recognition and sharing of savings 
                        with respect to reductions in the occurrence of 
                        health and pregnancy complications, 
                        hospitalization rates, medical errors, adverse 
                        drug reactions, and other occurrences, as 
                        defined by the Advisory Council;
                            (ix) allowance for additional payments for 
                        achieving measurable and continuous quality 
                        improvements, including under a process 
                        established by the Secretary for paying a 
                        performance-based bonus to women's medical 
                        homes which meet or achieve substantial 
                        improvements in performance (as specified under 
                        clinical, patient satisfaction, and efficiency 
                        benchmarks established by the Secretary in 
                        consultation with the Advisory Council);
                            (x) recognition of the existing payment 
                        methodology for federally qualified health 
                        centers when determining the most appropriate 
                        mechanism for providing bonus payments for 
                        women's medical home services delivered at such 
                        centers; and
                            (xi) such other methods as the Secretary, 
                        in consultation with the Advisory Council, 
                        finds appropriate;
                    (E) develop appropriate risk-adjustment mechanisms 
                to account for varying costs of women's medical homes 
                based upon characteristics of the eligible individuals 
                participating in the project;
                    (F) select the outcomes and quality measures and 
                level of improvements required to qualify for 
                performance-based bonus payments, with special 
                consideration such payments related to services and 
                outcomes described in clauses (i) through (ix) of 
                paragraph (1)(A); and
                    (G) evaluate the project in accordance with 
                subsection (d).
            (7) Planning or implementation grants.--The Secretary may 
        award planning or implementation grants to eligible entities 
        desiring or selected to participate in the project.
            (8) Ongoing oversight and performance assessment.--The 
        Secretary shall establish procedures to ensure that practices, 
        health centers, and clinics participating as women's medical 
        homes under the project, and the physicians, advance practice 
        nurses, and physician assistants providing services at such 
        practices, centers, and clinics, have access to confidential 
        feedback and benchmarking reports as a function of the 
        practice's, health center's, or clinic's monitoring of its 
        clinical process and performance (including process and outcome 
        measures).
            (9) Technical assistance.--The Secretary shall establish 
        mechanisms to provide technical assistance to practices, health 
        centers, and clinics participating as women's medical homes 
        under the project.
            (10) Payments to states.--The Secretary shall pay each 
        State participating in the project an amount equal to 100 
        percent of the amounts expended by the State for services 
        provided to an eligible individual under the project, including 
        administrative expenses.
    (c) Advisory Council.--
            (1) Establishment.--Not later than 60 days after the date 
        of enactment of this Act, the Secretary shall establish a 
        Women's Medical Home Advisory Council.
            (2) Terms of members.--
                    (A) In general.--Each appointed member of the 
                Advisory Council shall hold office for the duration of 
                the project.
                    (B) Vacancies.--The Secretary shall fill any 
                vacancy in the membership of the Advisory Council in 
                the same manner as the original appointment. The 
                vacancy shall not affect the power of the remaining 
                members to execute the duties of the Advisory Council.
            (3) Composition.--Membership in the Advisory Council shall 
        include--
                    (A) one representative from the Agency for 
                Healthcare Research and Quality;
                    (B) one representative from the Health Resources 
                and Services Administration;
                    (C) one representative from the Office of Women's 
                Health of the Department of Health and Human Services;
                    (D) one representative from the Centers for 
                Medicare & Medicaid Services;
                    (E) representatives from other appropriate Federal 
                agencies;
                    (F) four physicians who specialize in women's 
                health care, including 3 of which are board-certified 
                in obstetrics and gynecology;
                    (G) one certified nurse midwife;
                    (H) one advanced practice nurse;
                    (I) one physician assistant;
                    (J) one mental health professional;
                    (K) one individual with expertise in coding and 
                reimbursement-related issues;
                    (L) one individual with expertise in quality 
                improvement efforts; and
                    (M) one consumer representative.
            (4) Application of faca.--The Federal Advisory Committee 
        Act (5 U.S.C. App.) shall apply to the Advisory Council except 
        that, for purposes of section 14 of that Act, the Advisory 
        Council shall terminate 6 years after the date of the Secretary 
        establishes the Council.
            (5) Working groups.--The Secretary may convene additional 
        working groups to report to the Advisory Committee in order to 
        assist with fulfillment of its duties.
            (6) Duties.--It shall be the duty of the Advisory Council 
        to assist the Secretary in carrying out the Secretary's duties 
        under this section.
    (d) Evaluations and Project Reports.--
            (1) Annual interim evaluations and reports.--For each year 
        of the project, the Secretary, in consultation with the 
        Advisory Council, shall provide for an interim evaluation of 
        the project and shall submit to Congress reports on the results 
        of such evaluations.
            (2) Final evaluation and report.--The Secretary, in 
        consultation with the Advisory Council, shall provide for a 
        final evaluation of the project and shall submit to Congress, 
        not later than 1 year after completion of the project, a final 
        report on the project based on the results of such evaluation. 
        The final report required under this paragraph shall include--
                    (A) an assessment of quality improvements and 
                clinical outcomes as a result of the project;
                    (B) an assessment of patient and provider 
                satisfaction;
                    (C) an assessment of which women, based on 
                demographic factors, such as age, race, sexual 
                orientation, disability, ethnicity, and socioeconomic 
                status, benefit the most from participating in a 
                women's medical home;
                    (D) estimates of cost savings to Medicaid, CHIP, 
                and other Federal programs resulting from the project; 
                and
                    (E) recommendations for such legislation and 
                administrative action as the Secretary determines to be 
                appropriate.
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