110 HR 7192 IH: Preserving Patient Access to Primary Care Act U.S. House of Representatives 2008-09-27 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 110th CONGRESS 2d Session H. R. 7192 IN THE HOUSE OF REPRESENTATIVES September 27, 2008 Ms. Schwartz introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on the Judiciary, Education and Labor, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and to improve patient access to primary care services, and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Preserving Patient Access to Primary Care Act. (b)

Table of contents

The table of contents is as follows: Sec. 1. Short title; table of contents. Sec. 2. Findings. Sec. 3. Definitions. Title I—Medical education Sec. 101. Recruitment incentives. Sec. 102. Debt forgiveness, scholarships, and service obligations. Sec. 103. Deferment of loans during residency and internships. Sec. 104. Immigration and Nationality provisions. Sec. 105. Educating Medical Students about Primary Care Careers. Title II—Medicaid Related Provisions Sec. 201. Transformation grants to support patient centered medical homes under Medicaid and SCHIP. Sec. 202. Promoting Children's Access to Covered Health Services. Title III—Medicare provisions Subtitle A—Primary care Sec. 301. Reforming payment systems under Medicare to support primary care. Sec. 302. Coverage of patient-centered medical home services. Sec. 303. Medicare primary care payment equity and access provision. Sec. 304. Additional incentive payment program for primary care services furnished in health professional shortage areas. Sec. 305. Permanent extension of floor on Medicare work geographic adjustment under the Medicare physician fee schedule. Sec. 306. Permanent extension of Medicare incentive payment program for physician scarcity areas. Sec. 307. HHS study and report on the process for determining relative value under the Medicare physician fee schedule. Subtitle B—Preventive services Sec. 311. Eliminating time restriction for initial preventive physical examination. Sec. 312. Elimination of cost-sharing for preventive benefits under the Medicare program. Sec. 313. HHS study and report on facilitating the receipt of Medicare preventive services by Medicare beneficiaries. Subtitle C—Other provisions Sec. 321. HHS study and report on improving the ability of physicians to assist Medicare beneficiaries in obtaining needed prescriptions under Medicare part D. Sec. 322. Quality Improvement Organization Assistance for Physician Practices seeking to be patient-centered medical home practices. Sec. 323. HHS study and report on improved patient care through increased caregiver and physician interaction. Sec. 324. Improved patient care through expanded support for Limited English Proficiency services. Sec. 325. HHS study and report on use of real-time Medicare claims adjudication. Title IV—Studies Sec. 401. Study concerning the designation of primary care as a shortage profession. Sec. 402. Study concerning the education debt of medical school graduates. Sec. 403. Study on minority representation in primary care.

2.

Findings

Congress makes the following findings: (1)Approximately 21 percent of physicians who were board certified in general internal medicine during the early 1990s have left internal medicine, compared to a 5 percent departure rate for those who were certified in subspecialties of internal medicine. (2)The number of United States medical graduates going into family medicine has fallen by more than 50 percent from 1997 to 2005. (3)In 2007, only 88 percent of the available medicine residency positions were filled and only 42 percent of those were filled by United States medical school graduates. (4)In 2006, only 24 percent of third-year internal medicine resident intended to pursue careers in general internal medicine, down from 54 percent in 1998. (5)Primary care physicians serve as the point of first contact for most patients and are able to coordinate the care of the whole person, reducing unnecessary care and duplicative testing. (6)Primary care physicians practicing preventive care, including screening for illness and treating diseases, can help prevent complications that result in more costly care. (7)Patients with primary care physicians have lower health care expenditures and primary care is correlated with better health status, lower overall mortality, and longer life expectancy. (8)Higher proportions of primary care physicians are associated with significantly reduced utilization. (9)The United States has a higher ratio of specialists to primary care physicians than other industrialized nations and the population of the United States is growing faster than the expected rate of growth in the supply of primary care physicians. (10)The number of Americans age 65 and older, those eligible for Medicare and who use far more ambulatory care visits per person as those under age 65, is expected to double from 2000 to 2030. (11)A decrease in Federal spending to carry out programs authorized by title VII of the Public Health Service Act threatens the viability of one of the programs used to solve the problem of inadequate access to primary care. (12)The National Health Service Corps program has a proven record of supplying physicians to underserved areas, and has played an important role in expanding access for underserved populations in rural and inner city communities. (13)Individuals in many geographic areas, especially rural areas, lack adequate access to high quality preventive, primary health care, contributing to significant health disparities that impair America's public health and economic productivity. (14)About 20 percent of the population of the United States resides in primary medical care Health Professional Shortage Areas.

3.

Definitions

(a)

General definitions

In this Act: (1)

Chronic Care Coordination

In this Act, the term chronic care coordination means the coordination of services that is based on the Chronic Care Model that provides on-going health care to patients with chronic diseases that may include any of the following services: (A)The development of an initial plan of care, and subsequent appropriate revisions to such plan of care. (B)The management of, and referral for, medical and other health services, including interdisciplinary care conferences and management with other providers. (C)The monitoring and management of medications. (D)Patient education and counseling services. (E)Family caregiver education and counseling services. (F)Self-management services, including health education and risk appraisal to identify behavioral risk factors through self-assessment. (G)Providing access by telephone with physicians and other appropriate health care professionals, including 24-hour availability of such professionals for emergencies. (H)Management with the principal nonprofessional caregiver in the home. (I)Managing and facilitating transitions among health care professionals and across settings of care, including the following: (i)Pursuing the treatment option elected by the individual. (ii)Including any advance directive executed by the individual in the medical file of the individual. (J)Information about, and referral to, hospice care, including patient and family caregiver education and counseling about hospice care, and facilitating transition to hospice care when elected. (K)Information about, referral to, and management with, community services. (L)Such additional services for which payment would not otherwise be made under this title that the Secretary may specify that encourage the receipt of, or improve the effectiveness of, the services described in this paragraph. (2)

Critical shortage health facility

The term critical shortage health facility means a public or private nonprofit health facility that does not serve a health professional shortage area (as designated under section 332 of the Public Health Service Act), but that has a critical shortage of physicians (as determined by the Secretary) in the field of family practice, internal medicine and pediatrics. (3)

Primary care

The term primary care means the provision of integrated, high-quality, accessible health care services by health care providers who are accountable for addressing a full range of personal health and health care needs, developing a sustained partnership with patients, practicing in the context of family and community, and working to minimize disparities across population subgroups. (4)

Primary care physician

The term primary care physician means a physician (as defined in section 1886 of the Social Security Act) who is trained in the fields of family practice, internal medicine, and pediatrics who provides first contact, continuous, and comprehensive care to patients. (5)

Principal care

The term principal care means integrated, accessible health care that is provided by medical subspecialists that addresses the majority of the personal health care needs of patients with chronic conditions requiring the subspecialist’s expertise, and for whom the subspecialist assumes care management, developing a sustained physician-patient partnership and practicing within the context of family and community. (6)

Secretary

The term Secretary means the Secretary of Health and Human Services. (b)

Primary Medical Care Shortage Area

(1)

In general

In this Act, the term primary medical care shortage area or PMCSA means a geographic area with a shortage of physicians (as designated by the Secretary) in the field of family practice, internal medicine, or pediatrics, as designated in accordance with paragraph (2). (2)

Designation

To be designated by the Secretary as a PMCSA, the Secretary must find that the geographic area involved has an established shortage of primary care physicians for the population served. The Secretary shall make such a designation with respect to an urban or rural geographic area if the following criteria are met: (A)The area is a rational area for the delivery of primary medical care services. (B)One of the following conditions prevails within the area— (i)the area has a population to full-time-equivalent primary care physician ratio of at least 3,500 to 1; or (ii)the area has a population to full-time-equivalent primary care physician ratio of less than 3,500 to 1 but greater than 3,000 to 1 and has unusually high needs for primary care services or insufficient capacity of existing primary care providers. (C)Primary medical care professionals in contiguous geographic areas are over-utilized. (c)

Medically Underserved Area

(1)

In general

In this Act, the term medically underserved area or MUA means a rational service area with a demonstrable shortage of primary healthcare resources relative to the needs of the entire population within the service area as determined in accordance with paragraph (2) through the use of the Index of Medical Underservice (referred to in this subsection as the IMU) with respect to data on a service area. (2)

Determinations

Under criteria to be established by the Secretary with respect to the IMU, if a service area is determined by the Secretary to have a score of 62.0 or less, such area shall be eligible to be designated as a MUA. (3)

IMU variables

In establishing criteria under paragraph (2), the Secretary shall ensure that the following variable are utilized: (A)The ratio of primary medical care physicians per 1,000 individuals in the population of the area involved. (B)The infant mortality rate in the area involved. (C)The percentage of the population involved with incomes below the poverty level. (D)The percentage of the population involved age 65 or over. The value of each of such variables for the service area involved shall be converted by the Secretary to a weighted value, according to established criteria, and added together to obtain the area's IMU score. (d)

Patient Centered Medical Home

(1)

In general

In this Act, the term patient centered medical home means a physician-directed practice that has been certified by an organization under paragraph (2) as meeting the following standards: (A)The practice provides patients who elect to obtain care through a patient centered medical home (referred to as participating patients) with direct and ongoing access to a primary or principal care physician who accepts responsibility for providing first contact, continuous, and comprehensive care to the whole person, in collaboration with teams of other health professionals, including nurses and specialist physicians, as needed and appropriate. (B)The practice applies standards for access to care and communication with participating beneficiaries. (C)The practice has readily accessible, clinically useful information on participating patients that enables the practice to treat such patients comprehensively and systematically. (D)The practice maintains continuous relationships with participating patients by implementing evidence-based guidelines and applying such guidelines to the identified needs of individual beneficiaries over time and with the intensity needed by such beneficiaries. (E)The practice— (i)collaborates with participating patients 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 has in place the resources and processes necessary to achieve improvements in the management and coordination of care for participating patients. (G)The practice monitors its clinical process and performance (including outcome measures) in meeting the applicable standards under this paragraph and provides information in a form and manner specified by the Secretary with respect to such process and performance. (2)

Standard Setting and Qualification Process for Medical Homes

The Secretary shall establish a process for the selection of a qualified standard setting and certification organization— (A)to establish standards, consistent with this subsection, to enable medical practices to qualify as patient centered medical homes; and (B)to provide for the review and certification of medical practices as meeting such standards.