Sec. 1554 Access to Therapies
The Secretary of Health and Human Services may not, unless expressly authorized in the ACA, establish regulations that (1) unreasonably inhibit access to “appropriate Medical care;” (2) prevent “timely” access to care; (3) prevent providers and patients from discussing all relevant treatment options; (4) prevent providers from disclosing information to their patients that is relevant to making a treatment decision, (5) “violates the principles of informed consent and ethical standards of health care professionals;” or (6) would prevent a patient from obtaining treatment “for the full duration of [their] medical needs.”316
Sec. 2402 Removal of Barriers to Providing Home and Community-Based Services
The Secretary of Health and Human Services must establish regulations to guide states in developing “service systems” capable of (1) “allocat[ing] resources” in response to beneficiary needs; (2) Maximizing beneficiary independence; (3) Aiding beneficiaries in the “design [of] an individualized, self-directed, community-supported life;” and (4) Improving provider coordination and regulation in an effort to consistently administer programs and facilitate oversight and monitoring of the service system functions.317
Sec. 3503 Medication Management Services in Treatment of Chronic Disease
- Overview. The Secretary of Health and Human Services must, through the Patient Safety Research Center, award grants to entities for the purpose of providing medication management (MTM) services to “targeted individuals” with chronic diseases.318
- Eligible Entities. Entities are eligible for grants if they have the capacity to provide MTM services and submit an application to the Secretary that contains their plan for long-term financial sustainability, their plan, if applicable, for coordinating MTM services with community health teams or a primary care extension program, and any other information specified by the Secretary.319
- MTM Services. Entities must use grant funds to (1) assess the health status of patients; (2) create a “medication treatment plan” that reflects the treatment decisions made by the prescribing provider and the patient; (3) “selecting, initiating, modifying, recommending changes to, or administering medication therapy;” (4) monitor and evaluate the patient’s response to medication; (5) conduct “an initial comprehensive medication review to identify, resolve, and prevent medication-related problems” and follow up reviews on a quarterly basis and as scheduled by the prescribing provider; (6) keep documentation regarding the care provided; (7) share pharmacist recommendations and summaries of medication reviews with other appropriate health care providers; (8) provide patients with information, strategies, and support in an effort to increase patient adherence to medication regimens; (9) provide patients and their caregivers with information and training about the appropriate use of their medications; (10) coordinate “MTM services within the broader health care management services provided to the patient;” and (11) provide patients with any other MTM services that are used in other federal programs and within the professional scope of pharmacy practice.320
- Targeted Individuals. MTM services will be available to individuals that take at least 4 prescription medications, take “high risk” medications, have at least 2 chronic diseases, or have a high risk of experiencing problems with their medications.321
- Reporting. Grantees must submit reports to the Secretary that information specified by the Secretary. The Secretary must then provide Congress with a report that assesses and evaluates the effectiveness of the MTM services program and its impact on issues such as health care resource utilization.322
- Performance Measures. The Secretary may award grants to entities in order to develop MTM services performance measures.323
Sec. 3506 Program to Facilitate Shared Decision-making
- Overview. The “Program to Facilitate Shared Decision-making” will establish standards and create educational tools in an effort to make treatment decisions the result of an open communication between patients, patient representatives, and providers regarding available treatment options and the patient’s preferences and values.324
- Standards. The Secretary of Health and Human Services must contract with the National Quality Forum for the creation and endorsement of educational tools, termed “patient decision aids,” that will help patients discuss their beliefs and treatment options and with their provider so that the treatment decision is a reflection of the “treatment options, scientific evidence, circumstances, beliefs, and preferences.”325
- Programs. The Secretary, in coordination with relevant federal agencies, must create a program to develop and test patient decision aids and educate providers on use of such aids. The Secretary will carry out this program through grants or contracts.326
- Decision aid criteria. The decision aids created by grants must (1) have the capacity to engage patients and providers in informed decision-making; (2) contain current clinical evidence regarding treatment decisions; (3) present information in a form that is understandable by individuals regardless of their age, culture, educational background, and health literacy status; (4) provide an explanation in the event that evidence does not support a certain treatment over another treatment; and (5) address “decisions across the age span, including those affecting vulnerable populations including children.” 327
- Grants. The Secretary must award grants to create “Shared Decision-making Resource Centers.” These centers will help providers implement patient decision aids and will disseminate patient decision aid research and best practices. The Secretary must also award grants to providers to support their development and implementation of patient decision aids.328
Sec. 4003 Clinical and Community Preventive Services
- Overview. The Director of the Centers for Disease Control and Prevention (CDC) must create a “Community Preventive Services Task Force” that will review scientific evidence and create recommendations regarding the delivery of community preventive services that will be utilized by “individuals and organizations delivering population-based services” and policymakers.329
- Task Force Duties. The Task Force must: (1) identify topics for recommendations and interventions, including topics that address specific populations, social determinant of health, and health disparities; (2) Review and revise the recommendations and interventions at least once every five years; (3) Integrate their activities with the federal health objectives and health improvement targets; (4) improve the dissemination of their recommendations; (5) provide professionals, agencies, and organizations with technical assistance as they implement the recommendations; and (6) submit annual reports to Congress and relevant agencies regarding research gaps and priorities.330
CDC Duties. The Director must provide the Task Force with “administrative, research, and technical support.”331
Footnotes
- 316. Affordable Care Act §1554; 42 U.S.C. 18114.
- 317. Affordable Care Act §2402(a).
- 318. Affordable Care Act §3503; 42 U.S.C. 299b-35(a).
- 319. Affordable Care Act §3503; 42 U.S.C. 299b-35(b).
- 320. Affordable Care Act §3503; 42 U.S.C. 299b-35(c).
- 321. Affordable Care Act §3503; 42 U.S.C. 299b-35(d).
- 322. Affordable Care Act §3503; 42 U.S.C. 299b-35(f).
- 323. Affordable Care Act §3503; 42 U.S.C. 299b-35(g).
- 324. Affordable Care Act §3506; 42 U.S.C. 299b-36(a).
- 325. Affordable Care Act §3506; 42 U.S.C. 299b-36(c).
- 326. Affordable Care Act §3506; 42 U.S.C. 299b-36(d).
- 327. Affordable Care Act §3506; 42 U.S.C. 299b-36(d)(2).
- 328. Affordable Care Act §3506; 42 U.S.C. 299b-36(e).
- 329. Affordable Care Act § 4003(b); 42 U.S.C. 280g-10(a).
- 330. Affordable Care Act §4003(b); 42 U.S.C. 280g-10(b).
- 331. Affordable Care Act §4003(b); 42 U.S.C. 280g-10(c).
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