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Senate HELP Legistlation Pharmacy and Informatics Highlights

06/11/2009

Sandi Mitchell the past chair of the Am Medical Informatics Association Pharmaoinformatics work group (PIWG) and has been instrumental in influencing Senator Kennedy’s HELP group health reform legislation.  We all owe Sandi a debt of gratitude for your work.  Below are some of the bills highlights from a pharmacy and informatics point of view provided by Sandi.  The full Bill can be viewed here: http://help.senate.gov/BAI09A84_xml.pdf

TITLE IIIMPROVING THE QUALITY AND EFFICIENCY OF

HEALTH CARE

Subtitle ANational Strategy to Improve Health Care Quality

Sec. 201. National strategy.

Sec. 202. Interagency Working Group on Health Care Quality.

Sec. 203. Quality measure development.

Sec. 204. Quality measure endorsement; public reporting; data collection.

Sec. 205. Collection and analysis of quality measure data.

Subtitle BHealth Care Quality Improvements

Sec. 211. Health care delivery system research; Quality improvement technical

assistance.

Sec. 212. Grants to establish community health teams to support a medical home model.

Sec. 213. Grants to implement medication management services in treatment of chronic disease.

Page 13

‘‘SEC. 2707. ENSURING THE QUALITY OF CARE.

19 ‘‘(a) IN GENERAL.A group health plan and a health

20 insurance issuer offering group or individual health insur21

ance coverage shall develop and implement a reimburse22

ment structure for making payments to health care pro23

viders that provides incentives for

14

O:\BAI\BAI09A84.xml [file 1 of 6] S.L.C.

1 ‘‘(1) the provision of high quality health care

2 under the plan or coverage in a manner that in3

cludes

4 ‘‘(A) the implementation of case manage-

5 ment, care coordination, chronic disease man-

6 agement, and medication and care compliance

7 activities that includes the use of the medical

8 home model as defined in section 212 of the Af-

9 fordable Health Choices Act for treatment or

10 services under the plan or coverage;http://help.senate.gov/BAI09A84_xml.pdf ‘‘

Section 213 Page 265

SEC. 213. GRANTS TO IMPLEMENT MEDICATION MANAGE9

MENT SERVICES IN TREATMENT OF CHRONIC

10 DISEASE.

11 Title IX of the Public Health Service Act (42 U.S.C.

12 299 et seq.), as amended by section 211, is further amend

13 ed by inserting after section 936 the following:

14 ‘‘SEC. 935. GRANTS TO IMPLEMENT MEDICATION MANAGE-

15 MENT SERVICES IN TREATMENT OF CHRONIC

16 DISEASES.

17 ‘‘(a) IN GENERAL.The Secretary, acting through

18 the Patient Safety Research Center established in section

19 933 (referred to in this section as the Center) shall estab

20 lish a program to provide grants to eligible entities to im

21 plement medication management (referred to in this sec

22 tion as MTM) services provided by licensed pharmacists,

23 as a collaborative, multidisciplinary, inter-professional ap

24 proach to the treatment of chronic diseases for targeted

25 individuals, to improve the quality of care and reduce over

266

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1 all cost in the treatment of such diseases. The Secretary

2 shall commence the grant program not later than May 1,

3 2010.

4 ‘‘(b) ELIGIBLE ENTITIES.To be eligible to receive

5 a grant under subsection (a), an entity shall

6 ‘‘(1) provide a setting appropriate for MTM

7 services, as recommended by the experts described in

8 subsection (e);

9 ‘‘(2) submit to the Secretary a plan for achiev

10 ing long-term financial sustainability;

11 ‘‘(3) where applicable, submit a plan for coordi

12 nating MTM services through local community

13 health teams established in section 212 of the Af

14 fordable Health Choices Act or in collaboration with

15 primary care extension programs established in sec

16 tion 399T;

17 ‘‘(4) submit a plan for meeting the require

18 ments under subsection (c); and

19 ‘‘(5) submit to the Secretary such other infor

20 mation as the Secretary may require.

(c) MTM SERVICES TO TARGETED INDIVIDUALS.

22 The MTM services provided with the assistance of a grant

23 awarded under subsection (a) shall, as allowed by State

24 law including applicable collaborative pharmacy practice

25 agreements, include

267

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1 ‘‘(1) performing or obtaining necessary assess

2 ments of the health and functional status of each

3 patient receiving such MTM services;

4 ‘‘(2) formulating an MTM plan according to

5 therapeutic goals agreed upon by the prescriber and

6 the patient or caregiver or authorized representative

7 of the patient;

8 ‘‘(3) selecting, initiating, modifying, recom9

mending changes to, or administering MTM services;

10 ‘‘(4) monitoring, which may include access to,

11 ordering, or performing laboratory assessments, and

12 evaluating the response of the patient to therapy, in

13 cluding safety and effectiveness;

14 ‘‘(5) performing an initial comprehensive medi

15 cation review to identify, resolve, and prevent medi

16 cation-related problems, including adverse drug

17 events, quarterly targeted medication reviews for on

18 going monitoring, and additional followup intervene-

19 tions on a schedule developed collaboratively with

20 the prescriber;

21 ‘‘(6) documenting the care delivered and com

22 municating essential information about such care,

23 including a summary of the medication review, and

24 the recommendations of the pharmacist to other ap

268

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1 propriate health care providers of the patient in a

2 timely fashion;

3 ‘‘(7) providing education and training designed

4 to enhance the understanding and appropriate use of

5 the medications by the patient, caregiver, and other

6 authorized representative;

7 ‘‘(8) providing information, support services,

8 and resources and strategies designed to enhance

9 patient adherence with therapeutic regimens;

10 ‘‘(9) coordinating and integrating MTM serv

11

ices within the broader health care management

12 services provided to the patient; and

13 ‘‘(10) such other patient care services in al

14 lowed under with pharmacists scope of practice, in

15 accordance with Federal law.

16 ‘‘(d) TARGETED INDIVIDUALS.MTM services pro

17 vided by licensed pharmacists under a grant awarded

18 under subsection (a) shall be offered to targeted individ

19 uals who

20 ‘‘(1) take 4 or more prescribed medications (in

21 cluding over-the-counter and dietary supplements);

22 ‘‘(2) take any high risk medications;

23 ‘‘(3) have 2 or more chronic diseases, as identi

24 fied by the Secretary; or

269

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1 ‘‘(4) have undergone a transition of care, or

2 other factors, as determined by the Secretary, that

3 are likely to create a high risk of medication-related

4 problems.

5 ‘‘(e) CONSULTATION WITH EXPERTS.In designing

6 and implementing MTM services provided under grants

7 awarded under subsection (a), the Secretary shall consult

8 with Federal, State, private, public-private, and academic

9 entities, pharmacy and pharmacist organizations, health

10 care organizations, consumer advocates, chronic disease

11 groups, and other stakeholders involved with the research,

12 dissemination, and implementation of pharmacist-deliv

13 ered MTM services, as the Secretary determines appro

14 priate. The Secretary, in collaboration with this group,

15 shall determine whether it is possible to incorporate rapid

16 cycle process improvement concepts in use in other Fed

17 eral programs that have implemented MTM services.

18 ‘‘(f) REPORTING TO THE SECRETARY.An entity

19 that receives a grant under subsection (a) shall submit to

20 the Secretary a report that describes and evaluates, as re

21 quested by the Secretary, the activities carried out under

22 subsection (c), including quality measures endorsed under

23 399JJ, as determined by the Secretary.

270

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1 ‘‘(g) EVALUATION AND REPORT.The Secretary

2 shall submit to the relevant committees of Congress a re

3 port which shall

4 ‘‘(1) assess the clinical effectiveness of phar

5 macist-provided services under the MTM services

6 program, as compared to usual care, including an

7 evaluation of whether enrollees maintained better

8 health with fewer hospitalizations and emergency

9 room visits than similar patients not enrolled in the

10 program;

11 ‘‘(2) assess changes in overall health care re

12 source of targeted individuals;

13 ‘‘(3) assess patient and prescriber satisfaction

14 with MTM services;

15 ‘‘(4) assess the impact of patient-cost sharing

16 requirements on medication adherence and rec

17 ommendations for modifications;

18 ‘‘(5) identify and evaluate other factors that

19 may impact clinical and economic outcomes, include-

20 ing demographic characteristics, clinical characteris

21 tics, and health services use of the patient, as well

22 as characteristics of the regimen, pharmacy benefit,

23 and MTM services provided; and

24 ‘‘(6) evaluate of the extent to which partici

25 pating pharmacists who maintain a dispensing role

271

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1 have a conflict of interest in the provision of MTM

2 services, and if such conflict is found, provide rec

3 ommendations on how such a conflict might be ap

4 propriately addressed.

5 ‘‘(h) GRANT TO FUND DEVELOPMENT OF PERFORM6

ANCE MEASURES.Secretary may, through the quality

7 measure development program under section 931 of the

8 Public Health Service Act (as amended by this Act),

9 award grants or contracts to eligible entities for the pur

10 pose of funding the development of performance measures

11 that assess the use and effectiveness of medication therapy

12 management services.’’.

13 SEC. 214. DESIGN AND IMPLEMENTATION OF REGIONAL14

IZED SYSTEMS FOR EMERGENCY C

Page 325

SEC. 220. DEMONSTRATION PROGRAM TO INTEGRATE

2 QUALITY IMPROVEMENT AND PATIENT SAFE3

TY TRAINING INTO CLINICAL EDUCATION OF

4 HEALTH PROFESSIONALS.

5 (a) IN GENERAL.The Secretary may award grants

6 to eligible entities or consortia under this section to carry

7 out demonstration projects to develop and implement aca

8 demic curricula that integrates quality improvement and

9 patient safety in the clinical education of health profess-

10 sionals. Such awards shall be made on a competitive basis

11 and pursuant to peer review.

12 (b) ELIGIBILITY.To be eligible to receive a grant

13 under subsection (a), an entity or consortium shall

14 (1) submit to the Secretary an application at

15 such time, in such manner, and containing such in

16 formation as the Secretary may require;

17 (2) be or include

18 (A) a health professions school;

19 (B) a school of public health;

20 (C) a school of social work;

21 (D) a school of nursing;

22 (E) a school of pharmacy;

23 (F) an institution with a graduate medical

24 education program; or

25 (G) a school of health care administration;

326

O:\KER\KER09411.xml [file 2 of 6] S.L.C.

1 (3) collaborate in the development of curricula

2 described in subsection (a) with an organization that

3 accredits such school or institution;

4 (4) provide for the collection of data regarding

5 the effectiveness of the demonstration project; and

6 (5) provide matching funds in accordance with

7 subsection (c).

8 (c) MATCHING FUNDS.

9 (1) IN GENERAL.The Secretary may award a

10 grant to an entity or consortium under this section

11 only if the entity or consortium agrees to make

12 available non-Federal contributions toward the costs

13 of the program to be funded under the grant in an

14 amount that is not less than $1 for each $5 of Fed

15 eral funds provided under the grant.

16 (2) DETERMINATION OF AMOUNT CONTRIB

17 UTED.Non-Federal contributions under paragraph

18 (1) may be in cash or in kind, fairly evaluated, in

19 cluding equipment or services. Amounts provided by

20 the Federal Government, or services assisted or sub

21 sidized to any significant extent by the Federal Gov

22 ernment, may not be included in determining the

23 amount of such contributions.

24 (d) EVALUATION.The Secretary shall take such ac

25 tion as may be necessary to evaluate the projects funded

327

O:\KER\KER09411.xml [file 2 of 6] S.L.C.

1 under this section and publish, make publicly available,

2 and disseminate the results of such evaluations on as wide

3 a basis as is practicable.

4 (e) REPORTS.Not later than 2 years after the date

5 of enactment of this section, and annually thereafter, the

6 Secretary shall submit to the Committee on Health, Edu

7 cation, Labor, and Pensions and the Committee on Fi

8 nance of the Senate and the Committee

Page 512

13 SEC. 435. GERIATRIC EDUCATION AND TRAINING; CAREER

14 AWARDS; COMPREHENSIVE GERIATRIC EDU15

CATION.

16 (a) WORKFORCE DEVELOPMENT; CAREER

17 AWARDS.Section 753 of the Public Health Service Act

18 (42 U.S.C. 294) is amended by adding at the end the fol

19 lowing:

20 ‘‘(d) GERIATRIC WORKFORCE DEVELOPMENT.

21 ‘‘(1

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