Article 5.5. Assistance To Children At Home Demonstration Project of California Health And Safety Code >> Division 106. >> Part 2. >> Chapter 3. >> Article 5.5.

(a) It is the intent of the Legislature to establish demonstration projects to assist medically fragile infants, children, and adolescents.
  (b) It is further the intent of the Legislature that these demonstration projects serve as models for methods of providing primary care services and coordination of health care for medically fragile infants, children, and adolescents.
  (c) The Legislature finds and declares that the use of care management services under these demonstration projects will lead to savings in medical costs through reduced emergency room visits, hospital admissions, and other medical indicators and measures.

There is hereby established demonstration projects to provide a medical home and coordination of care model in order to reduce avoidable health problems of chronically, seriously ill infants, children, and adolescents. The demonstration projects may operate for a period of up to three years. Existing demonstration projects may be extended for up to two years, if outcome data display effectiveness as determined by the State Department of Health Services.

The department shall award funding appropriated for purposes of this article, on a competitive basis, to any nonprofit children's hospitals, as defined in Section 10727 of the Welfare and Institutions Code, and other hospitals that operate at least 10 special care centers, as certified by the California Childrens' Services Program.

The demonstration projects shall provide care management services to children enrolled in the demonstration projects pursuant to proposals accepted by the department. Demonstration projects shall meet all of the following requirements:
  (a) Establish and function as a medical home to a population of infants, children, and adolescents whose medical conditions requires multidisciplinary and multispecialty care.
  (b) Provide care coordination between primary care and specialty health care providers and community agencies for project enrollees.
  (c) Provide, or arrange for the provision of, health care services to maintain optimal health status. These services may include, but need not be limited to, physician office or home visits, psychosocial counseling, and medical nutrition evaluation and counseling.
  (d) Establish a relationship with an enrollee's parent or guardian in order to enhance the understanding of the child's condition and the parent or guardian's participation in the enrollee's medical treatment plan and decisionmaking.
  (e) Maximize the use of third-party reimbursement for the services provided to the population enrolled in the project.

In order to most effectively assist children enrolled in the demonstration project, the demonstration project may employ the use of clinic visits, home visits, school visits, inpatient visits, and multidisciplinary conferences, as well as other innovative care management techniques.

(a) The hospital receiving funding under this article shall submit a report to the department that evaluates the demonstration project and includes measures of medical costs and improved health outcomes of enrollees.
  (b) The report shall address the following outcome measures as identified in the hospital's demonstration project submitted to the department for approval.
  (c) The report required by subdivision (a) shall include a determination as to whether the demonstration project is deemed to be successful. Unless other outcome measures are used pursuant to subdivision (d), the demonstration project shall be deemed to be successful if all of the following have occurred:
  (1) The average number of school days missed is decreased by 50 percent.
  (2) The average number of emergency room visits is decreased by 50 percent.
  (3) The average number of hospitalizations and hospital days is decreased by 50 percent.
  (4) The number of children with up-to-date immunizations is increased by 50 percent.
  (d) The demonstration project may use other outcome measures in lieu of those identified in subdivision (c), if deemed appropriate by the department, to measure success.
  (e) The determinations made pursuant to this subdivision shall be based on a comparison of the preprogram utilization rates, which is data collected one year prior to enrollment in the program, with the utilization rates one year after enrollment.