Table 2.

Summary of Selected State and Federal Enacted Legislation Referencing the Medical Home

EntityMedical Home Definition and AttributesImpact of Legislation
US Congress PL 109–432 (12/20/2006)
  • Care planning and coordination

  • Use of health information technology

  • Personal physician within a medical home practice

  • Individual health assessment and management plans

  • Prospective care management fee

  • 3-year medical home demonstration for “high need” Medicare beneficiaries

  • Demonstration to run in 8 states with mix of practice types and locations

  • Requires CMS to create care management fee codes and provide a prospective fee for care management

California SL Ch. 483 (10/112007)Defines medical home as “a single provider or facility that maintains all of an individual's medical information. The ···provider shall be a provider from which the enrollee can access primary and preventive care.”Establishes the availability of medical homes as one of 10 criteria to judge local government proposals for insurance coverage expansion under an existing Medicaid waiver demonstration project
Idaho H 168 (7/1/2007)Defines medical home as a primary care case manager
  • Requires all Medicaid applicants to receive information about primary care case management

  • Allows the state HHS Director to require Medicaid enrollees to designate a primary care case manager

Louisiana Act 243 (8/15/2007)Defines medical home “system of care” that includes:
  • PCP-directed, patient-centered care

  • Coordination of preventive and primary care

  • Integrated system of PCPs, specialists and hospitals

  • PCPs must have EMR

  • Requires the state department of health to develop, implement, and evaluate a medical home system of care for Medicaid and low-income uninsured

  • Requires the state department of health to develop an “enhanced Medicaid reimbursement methodology” for participating providers

Minnesota H 1078, SL 147 (7/1/2007)Primary care medical homes must include the following attributes:
  • Comprehensive care, including chronic disease management

  • Coordination of care

  • Longitudinal care

  • 24-hour access (via phone)

  • Systematic process for quality improvement

  • Requires the state human services commissioner to develop at least 4 primary care medical home pilot projects for Medicaid-enrolled children or adults with complex medical needs

  • Requires an evaluation of the pilot projects

  • Appropriation of about $1.7 million over 2 years (2009 and 2010)

Vermont Act 0071 (6/5/2007)Defines medical home as a primary care practice that provides access to personal health information, individualized health assessments, and training for office staff in care management. Medical home PCPs shall provide:
  • Care coordination, integration and oversight

  • Point-of-care EBM and decision support tools

  • Use of health information technology

  • Patient self-management tools

  • Funds a medical home demonstration project for Medicaid, Catamount Health, and State Employee Health Plan enrollees

  • Requires the state DHS to develop a care management fee schedule and performance-based incentive payment structure for demonstration sites

  • Establishes community-based care coordination teams that will work with medical home practices to coordinate care and promote the medical home

Washington PL Ch 259 (7/22/2007)Defines medical home as “a site of care that provides comprehensive preventive and coordinated care centered on the patient's needs and assures high-quality, accessible, and efficient care”
  • Requires the state department of health to develop a 5-year plan to provide a medical home to all enrollees of state health plans

  • Requires the state DOH to design and implement medical homes for aging, blind, and disabled clients

  • Payment reform emphasized, with the goal of allowing primary care providers to remain in practice and better coordinate chronic disease care.

  • CMS, Centers for Medicare and Medicaid Services; HHS, Health and Human Services; DOH, Department of Health; PCP, primary care provider; EMR, electronic medical record; EBM, evidence-based medicine; DHS, Department of Human Services.