First Regular Session Sixty-eighth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 11-0439.01 Brita Darling HOUSE BILL 11-1245 HOUSE SPONSORSHIP Kefalas, SENATE SPONSORSHIP Aguilar, House Committees Senate Committees State, Veterans, & Military Affairs A BILL FOR AN ACT Concerning payment reforms for the creation of patient-centered medical homes for adults. Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries.) The bill defines a patient-centered medical home as one that provides services to adults, including the core principles relating to patient-centered medical homes. No later than January 1, 2014, the bill requires public payors and health insurance carriers to make care coordination payments to health care providers who provide services as part of a patient-centered medical home. The bill does not prohibit nor discourage public payors and health insurance carriers from making care coordination payments prior to January 1, 2014, and does not prohibit the implementation of payment reform, care coordination, or health care delivery reform developed or initiated on or before the effective date of the bill. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Part 1 of article 16 of title 10, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 10-16-138. Care coordination payments for patient-centered medical homes. (1) No later than January 1, 2014, each carrier shall make care coordination payments to a health care provider who provides services as part of a patient-centered medical home, as defined in section 25.5-1-103, C.R.S. (2) Nothing in this section shall prohibit or discourage a carrier from making care coordination payments pursuant to subsection (1) of this section prior to January 1, 2014. (3) Nothing in this section shall prohibit the implementation of any other payment reform, care coordination, or health care delivery reform developed or initiated on or before the effective date of this section. SECTION 2. 25.5-1-103, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SUBSECTION to read: 25.5-1-103. Definitions. As used in this title, unless the context otherwise requires: (5.7) (a) "Patient-centered medical home" means a health care team that provides high-quality, safe, continuous, coordinated, comprehensive, and evidence-based care to adults. A patient-centered medical home facilitates a partnership between adult patients and their personal health care team. (b) A patient-centered medical home is one that meets the criteria of a nationally recognized accrediting organization that develops performance measures and quality standards for health care entities, and is based upon core principles, including but not limited to: (I) Enhanced access to care; (II) Comprehensive, culturally competent, evidence-based, and patient-centered care; (III) Care management and coordination; (IV) Cost effectiveness and efficiency; (V) Quality and safety; (VI) Continuity of care; and (VII) Whole-person orientation with the aim of preventing conditions or complications before they occur. SECTION 3. Article 1 of title 25.5, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 25.5-1-123.5. Patient-centered medical homes for adults - legislative declaration - care coordination payments. (1) (a) The general assembly hereby finds and declares that: (I) Colorado's health and economic security are at risk due to rising health care costs; and (II) The lack of comprehensive and coordinated care is inefficient and results in less favorable health care outcomes and wasted resources. (b) The general assembly further finds that: (I) A high-performance health care delivery system includes key elements such as affordable care; payments aligned with value; accountable, accessible, patient-centered and coordinated care; and continuous quality improvement focused on the patient's health and health care experience; and (II) Colorado health care stakeholders, including providers, payors, purchasers, consumers, and policy experts, are fully engaged in redesigning our state's health care system to improve performance and health outcomes and to lower health care costs. (c) It is therefore the intent of the general assembly to promote and encourage the creation of patient-centered medical homes for adults. One way to achieve this goal is through the creation of comprehensive health care payment reforms. (2) (a) No later than January 1, 2014, each public payor and carrier, as defined in section 10-16-102, C.R.S., shall make care coordination payments to a health care provider who provides services as part of a patient-centered medical home. (b) Nothing in this section shall prohibit or discourage a public payor or a carrier, as defined in section 10-16-102, C.R.S., from making care coordination payments pursuant to paragraph (a) of this subsection (2) prior to January 1, 2014. (3) Nothing in this section shall prohibit the implementation of any other payment reform, care coordination, or health care delivery reform developed or initiated on or before the effective date of this section. SECTION 4. Act subject to petition - effective date. This act shall take effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly (August 10, 2011, if adjournment sine die is on May 11, 2011); except that, if a referendum petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within such period, then the act, item, section, or part shall not take effect unless approved by the people at the general election to be held in November 2012 and shall take effect on the date of the official declaration of the vote thereon by the governor.