124 STAT. 514 PUBLIC LAW 111–148—MAR. 23, 2010 (6) submit to the Secretary an application at such time, in such manner, and containing such information as the Sec- retary may require. (c) REQUIREMENTS FOR HEALTH TEAMS.—A health team estab- lished pursuant to a grant or contract under subsection (a) shall— (1) establish contractual agreements with primary care pro- viders to provide support services; (2) support patient-centered medical homes, defined as a mode of care that includes— (A) personal physicians; (B) whole person orientation; (C) coordinated and integrated care; (D) safe and high-quality care through evidence- informed medicine, appropriate use of health information technology, and continuous quality improvements; (E) expanded access to care; and (F) payment that recognizes added value from addi- tional components of patient-centered care; (3) collaborate with local primary care providers and existing State and community based resources to coordinate disease prevention, chronic disease management, transitioning between health care providers and settings and case manage- ment for patients, including children, with priority given to those amenable to prevention and with chronic diseases or conditions identified by the Secretary; (4) in collaboration with local health care providers, develop and implement interdisciplinary, interprofessional care plans that integrate clinical and community preventive and health promotion services for patients, including children, with a pri- ority given to those amenable to prevention and with chronic diseases or conditions identified by the Secretary; (5) incorporate health care providers, patients, caregivers, and authorized representatives in program design and over- sight; (6) provide support necessary for local primary care pro- viders to— (A) coordinate and provide access to high-quality health care services; (B) coordinate and provide access to preventive and health promotion services; (C) provide access to appropriate specialty care and inpatient services; (D) provide quality-driven, cost-effective, culturally appropriate, and patient- and family-centered health care; (E) provide access to pharmacist-delivered medication management services, including medication reconciliation; (F) provide coordination of the appropriate use of com- plementary and alternative (CAM) services to those who request such services; (G) promote effective strategies for treatment planning, monitoring health outcomes and resource use, sharing information, treatment decision support, and organizing care to avoid duplication of service and other medical management approaches intended to improve quality and value of health care services; (H) provide local access to the continuum of health care services in the most appropriate setting, including Plans.
