42 U.S.C. § 280g–12 — Primary Care Extension Program

(a) Establishment, purpose and definitions: (1) The Secretary, through the Director of the Agency for Healthcare Research and Quality, must create a Primary Care Extension Program. (2) Its purpose is to help primary care providers learn about prevention, chronic disease management, and mental/behavioral health care (including substance abuse prevention and treatment) and evidence-based or evidence-informed methods, using local "Health Extension Agents" to link providers with community health resources. (3) Definitions: A "Health Extension Agent" is a local community health worker who helps primary care practices improve quality through patient-centered medical home principles, guides patients in culturally and linguistically appropriate ways, and links practices to health system resources. A "primary care provider" is a clinician, recognized by a State licensing or regulatory authority, who gives integrated, accessible care to people of all ages, is accountable for most of a patient's health needs, and builds a lasting patient partnership, unless this section says otherwise. (b) Grants to establish State Hubs and local Primary Care Extension Agencies: (1) The Secretary must award competitive grants to States to build State- or multistate-level "Hubs." (2) A Hub must include, at minimum, the State health department, the State Medicaid administrator (if different), the State-level Medicare entity, and the departments training primary care providers at one or more health professions schools in the State; it may also include hospital associations, primary care research networks, professional societies, State primary care associations, licensing boards, quality-review contractors, consumer groups, and other appropriate entities. (c) State and local activities: (1) Hubs must (A) send the Secretary a plan to coordinate with quality improvement organizations and area health education centers, if those aren't already Hub members; (B) contract with a county- or local-level entity to serve as the Primary Care Extension Agency; (C) organize and manage grant funds passed down to local Agencies serving a catchment area the State sets; and (D) build statewide or multistate networks of local Agencies to share information and practices. (2)(A) Local Agencies must (i) help providers build a patient-centered medical home, including health homes, to improve access, quality, and efficiency; (ii) build learning communities to spread research findings, assess practice improvement, share best practices, and involve community clinicians in research; (iii) join a national network of Hubs and share lessons and best practices; and (iv) plan for financial sustainability using State, local, and private funds, to offset the expected drop in federal funds after the first 6 years. (B) Local Agencies may (i) give technical assistance, training, and support to community health teams; (ii) collect data and give providers feedback from standardized measures to aid ongoing improvement; (iii) work with local health departments, community health centers, tribes, and other agencies on community health priorities and workforce needs, and join efforts to address social and primary health determinants, strengthen the local workforce, and cut health disparities; (iv) develop ways to measure the program's impact on enrollees and the wider community; and (v) do other work the Secretary approves. (d) Federal program administration: (1) Grants are either (A) 6-year "program grants" for States or multistate entities with a fully-developed Hub plan, or (B) 2-year "planning grants" to help build that plan. (2) States or multistate entities must apply as the Secretary requires. (3) An evaluation panel the Secretary appoints reviews each State at the end of its grant period. (4) After the sixth year, a State may keep getting support if its program performance and sustainability plan get satisfactory evaluations, as the Secretary determines. (5) A State can't spend more than 10 percent of its grant on administration, and grant funds can't pay for direct patient care. (e) Requirements on the Secretary: The Secretary must consult the heads of other federal agencies with health care and preventive medicine expertise -- such as the CDC, SAMHSA, HRSA, NIH, the Office of the National Coordinator for Health IT, the Indian Health Service, and USDA's Cooperative Extension Service -- and other entities as appropriate. (f) Authorization of appropriations: Congress may spend $120,000,000 for each of fiscal years 2011 and 2012, and whatever sums are needed for 2013 and 2014.