SB0101

SENATE BILL 101

54th legislature - STATE OF NEW MEXICO - first session, 2019

INTRODUCED BY

Jeff Steinborn and Deborah A. Armstrong

AN ACT

RELATING TO HEALTH; ENACTING THE HEALTH CARE VALUE AND ACCESS COMMISSION ACT; ESTABLISHING THE HEALTH CARE VALUE AND ACCESS COMMISSION; PROVIDING FOR THE COMMISSION'S POWERS AND DUTIES; GRANTING RULEMAKING AND ASSESSMENT AUTHORITY TO THE COMMISSION; CREATING REPORTING REQUIREMENTS; ESTABLISHING THE HEALTH CARE VALUE AND ACCESS COMMISSION FUND; AMENDING A SECTION OF THE HEALTH INFORMATION SYSTEM ACT TO PROVIDE FOR THE SHARING OF DEPARTMENT OF HEALTH DATA WITH THE HEALTH CARE VALUE AND ACCESS COMMISSION; REPEALING A SECTION OF THE DEPARTMENT OF HEALTH ACT; MAKING AN APPROPRIATION; DECLARING AN EMERGENCY.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

SECTION 1. [NEW MATERIAL] SHORT TITLE.--Sections 1 through 10 of this act may be cited as the "Health Care Value and Access Commission Act".

SECTION 2. [NEW MATERIAL] DEFINITIONS.--As used in the Health Care Value and Access Commission Act:

A. "chair" means the chair of the commission;

B. "commission" means the health care value and access commission;

C. "health care provider association" means an organization that represents the interests of persons who are licensed, certified or otherwise authorized to provide health care in the state in the ordinary course of business;

D. "health coverage" means the following types of health coverage delivered or issued for delivery in this state:

(1) group health coverage governed by the provisions of the Health Care Purchasing Act;

(2) individual health insurance policies, health benefits plans and certificates of insurance governed by the provisions of Chapter 59A, Article 22 NMSA 1978;

(3) multiple-employer welfare arrangements governed by the provisions of Section 59A-15-20 NMSA 1978;

(4) group and blanket health insurance policies, health benefits plans and certificates of insurance governed by the provisions of Chapter 59A, Article 23 NMSA 1978;

(5) individual and group health maintenance organization contracts governed by the provisions of the Health Maintenance Organization Law;

(6) individual and group nonprofit health benefits plans governed by the provisions of the Nonprofit Health Care Plan Law;

(7) medicare or medicare supplement plans; or

(8) medical assistance plans governed by the provisions of the Public Assistance Act;

E. "health coverage entity" means an entity that is subject to the laws of this state and that contracts or offers to contract, or enters into agreements to provide, deliver, arrange for, pay for or reimburse any costs of health care services, or that provides, offers or administers health benefits plans or managed health care plans in this state. A "health coverage entity" includes a health insurance company, a health maintenance organization, a managed care organization, a third-party administrator, a hospital and health services corporation, a provider service network or a nonprofit health care plan;

F. "member" means a member of the commission;

G. "provider" means a licensed health care professional or a hospital or other facility authorized to furnish health care services in the state; and

H. "superintendent" means the superintendent of insurance.

SECTION 3. [NEW MATERIAL] HEALTH CARE VALUE AND ACCESS COMMISSION CREATED--DUTIES--POWERS.--

A. As of June 1, 2019, the "health care value and access commission" is created as an adjunct agency, in accordance with the provisions of the Executive Reorganization Act, to provide oversight and implement recommendations to ensure the sustainability of the health care system in the state.

B. Except as provided in Paragraph (13) of Subsection C of this section, the superintendent shall adopt and promulgate rules necessary to carry out the provisions of the Health Care Value and Access Commission Act.

C. The commission shall:

(1) collect data provided by state agencies pursuant to memoranda of agreement that the commission executes with those agencies;

(2) provide focused comprehensive analyses of state health care data, including claims data obtained through an all-payer claims database; cost data; utilization data; and financial information, to enable the development of a baseline of expenditures, quality indicators and utilization of the health care system as a whole;

(3) prepare for state and federal changes to payments in coordination with all payers and the health care delivery system in the state;

(4) identify innovative responses to address problems with access to care and monitor effectiveness of mitigating strategies;

(5) take steps to identify and remove waste and inefficiency that add no value, identify high-functioning health care delivery and coverage entities and outliers and propose reinvestment in feasible strategies;

(6) propose new strategies to address emerging challenges in the provision of access to high-quality, affordable health care;

(7) review reports from health coverage entities and other relevant entities pertaining to efforts to reduce costs through health improvement strategies, health indicator and outcome reporting, compensation models for incentivizing clinical preventive services, social intervention strategies, cost and value and related care coordination and health impact analyses;

(8) review reports from health coverage entities and applicable state agencies and health care delivery organizations related to provider network adequacy and primary care access, including geographic analysis of comprehensive services such as locally available obstetrics and pediatrics services;

(9) seek and receive grant funding from federal, state or local governments or private philanthropic organizations, including in-kind contributions, to defray the costs of operating the commission;

(10) generate funding, including charging assessments or fees, to support the commission's operations in accordance with the duties of the commission, solely for the administrative and operational costs of the commission;

(11) assess proposals by state agencies and other entities concerned with payment of health care costs and changes to existing delivery, coverage and payment systems; provided that an assessment shall:

(a) be made independently of outside interference;

(b) be completed before implementation; and

(12) review proposed private and public health care delivery system capital building and expansion, or consolidation or elimination of services, and issue a public report on the impact of these changes on access, cost and risk to the public health of the population that the proposed capital building and expansion, or consolidation or elimination of services, represents;

(13) in accordance with the State Rules Act, adopt and promulgate rules as necessary to establish and administer an all-payer claims database in accordance with the provisions of the Health Care Value and Access Commission Act; and

(14) recommend to the superintendent, for adoption and promulgation by the office of superintendent of insurance, rules that the commission deems necessary to carry out the provisions of the Health Care Value and Access Commission Act.

D. The commission may:

(1) request and receive data collected by providers, health care provider associations and health coverage entities;

(2) sue or be sued or otherwise take any necessary or proper legal action in the execution of its duties and powers; and

(3) when necessary for an audit or examination, apply to the district court of Santa Fe county for issuance of a subpoena to compel the attendance of witnesses and the production of books and records. Process under this paragraph shall be served by any sheriff or deputy or by any member of the New Mexico state police without cost. Witnesses not then employed by an agency who are subpoenaed to appear shall receive the same compensation as that provided for witnesses subpoenaed before the district court, paid by the commission.

E. The chair may examine persons, administer oaths and require production of papers and records.

F. The commission shall be subject to and comply with the provisions of the:

(1) Open Meetings Act;

(2) State Rules Act;

(3) Inspection of Public Records Act;

(4) Public Records Act;

(5) Financial Disclosure Act;

(6) Accountability in Government Act;

(7) Gift Act;

(8) Tort Claims Act; and

(9) Per Diem and Mileage Act.

G. The commission shall not be subject to the provisions of the Procurement Code or the Personnel Act.

SECTION 4. [NEW MATERIAL] PROVIDERS--HEALTH COVERAGE ENTITIES--STATE AGENCIES--MANDATORY REPORTING.--Upon the commission's request, a provider, health coverage entity or state agency shall provide health care data that the commission requests.

SECTION 5. [NEW MATERIAL] COMMISSION MEMBERSHIP--APPOINTMENT--TERMS--VOTING.--

A. The commission shall consist of nine voting members, each of whom are residents of New Mexico, as follows:

(1) five members, one from each of the five public regulation commission districts, which members shall include:

(a) two members appointed by the governor; and

(b) three members appointed by the New Mexico legislative council;

(2) a member of a federally recognized Native American tribe, nation or pueblo, appointed by the governor;

(3) one public member appointed by the governor;

(4) the director of the legislative finance committee, ex officio; and

(5) the superintendent, ex officio.

B. An appointed member or any member of an appointed member's immediate family or household shall not have any income derived from current or active employment, contract or consultation with the private health care delivery, financing or coverage sector while serving on the commission and for the twelve months preceding appointment to the commission.

C. Political party membership on the commission shall not be exclusively representative of a single political party.

D. Appointed members shall have at least three years' experience in one of the following areas and shall be selected as follows, coordinated between the governor and the New Mexico legislative council to not duplicate skills:

(1) no more than two members shall have executive-level experience in management or finance in a business related to health care or health economics;

(2) at least one member shall have experience in the field of health or human services consumer advocacy;

(3) at least one member shall have experience in management or finance not related to health care;

(4) at least one member, who shall not be a current public official, shall have experience related to health care policy; and

(5) at least one member shall have experience related to purchasing or negotiating health care benefits for employees.

E. By July 1, 2019, the governor shall call the first meeting of the commission. At that meeting:

(1) members shall choose a chair, who shall call subsequent meetings of the commission, and a vice chair, who shall call subsequent meetings when the chair is unavailable; provided that thereafter, the commission shall elect its chair and vice chair in open session in even-numbered years from among the members; and

(2) appointed members shall choose their initial terms by lot as follows:

(a) two members shall serve two-year terms;

(b) two members shall serve three-year terms; and

F. After expiration of the commission's initial terms, members shall serve four-year terms. An appointed member shall serve until the member's successor is appointed and qualified.

G. The commission shall meet at the call of the chair. It shall meet at least once monthly from July 1, 2019 until December 31, 2020 and thereafter no less than once per calendar quarter.

H. A majority of members constitutes a quorum. The commission may allow members' participation in meetings by telephone or by other electronic media that allow full participation.

I. A chair or vice chair shall serve no more than two consecutive two-year terms.

J. A vacancy shall be filled by appointment by the original appointing authority in accordance with the provisions of Subsection A of this section. The newly appointed member shall serve for the remainder of the unexpired vacated term.

K. An appointed member may be removed from the commission by a majority vote of the members. The commission shall set standards for attendance and may remove a member for lack of attendance, neglect of duty or malfeasance in office. An appointed member shall not be removed without proceedings consisting of at least one notice of hearing and an opportunity to be heard. Removal proceedings shall take place before the commission and in accordance with rules adopted by the commission.

L. Appointed members may receive per diem and mileage in accordance with the Per Diem and Mileage Act, subject to appropriation by the legislature. Appointed members shall receive no other compensation, perquisite or allowance for their service on the commission.

SECTION 6. [NEW MATERIAL] REPORTING AND USE OF DATA.--

A. In a format specified in memoranda of agreement between the following entities and the commission, the following entities shall share data as requested by the commission, which data shall relate to health coverage and services to allow the commission to measure utilization, costs, charges and outcomes achieved:

(1) the department of health;

(2) the human services department;

(3) the children, youth and families department;

(4) the aging and long-term services department;

(5) the corrections department;

(6) provider licensing boards;

(7) the office of superintendent of insurance;

(8) the risk management division of the general services department;

(9) the retiree health care authority;

(10) the Albuquerque public school district;

(11) the public school insurance authority;

(12) the New Mexico health insurance exchange;

(13) the university of New Mexico;

(14) any other state or county instrumentality that the commission specifies;

(15) health coverage entities doing business in the state; and

(16) any provider doing business in the state.

B. Data shall be reported electronically in aggregate form, except where the commission deems that de-identified patient-specific data are necessary to provide unduplicated information. The commission shall report data received only in aggregate form and shall not release any individual-identifying information or corporate proprietary information for any purpose except as provided by state law, federal law or court order.

C. In developing data reporting rules, the commission shall seek and consider input from providers, health care provider associations and health coverage entities as the commission deems relevant on:

(1) the format, timing and method of transmission of data from the entities listed in Subsection A of this section;

(2) the prevention of duplicative reporting; and

(3) strategies for making data reporting the least burdensome possible.

D. The commission shall not request data that a state or county instrumentality has collected and could submit to the commission.

E. The commission shall conduct periodic audits to ensure the general accuracy of the financial data submitted to the commission.

F. Notwithstanding any other provision of this section, if a provider, health care provider association or health coverage entity deems that information contained in data submission contains material that it considers to be a trade secret, it shall include that information in a separate section of its submission and include a request for the commission to consider and determine whether that information should be kept confidential.

G. The commission shall propose to the superintendent rules for adoption that relate to data storage and data sharing to make data available to other state agencies and for academic and analytical purposes in accordance with state and federal privacy laws.

SECTION 7. [NEW MATERIAL] CREATION OF ADVISORY COUNCILS.--The commission shall create ad hoc or permanent advisory councils for content expertise. The commission shall determine in its first year the number and composition of advisory councils that will be permanent. The commission shall seek input on what issues to prioritize from health care delivery system experts and health coverage entities.

SECTION 8. [NEW MATERIAL] OPERATIONAL PLAN.--

A. By November 1, 2020, the commission shall develop a comprehensive operational plan describing the commission's time line and implementation strategy, including any policy or legislative recommendations, for building research, analysis and advisory capacity. The commission shall present the operational plan and recommendations to the legislature and governor. The operational plan and recommendations shall include preliminary reporting with definitions of priorities for the first year of the commission's operation and plans for addressing current priorities and time frames for the following and any new or unexpected priorities that the commission deems to be of more urgent necessity:

(1) the need for a time frame to complete an in-depth review of expenditures, cost drivers, payment and service delivery components of the total health care sector in the state and a cost growth estimate;

(2) a time frame and steps to fund and implement an all-payer claims database, including its location, relationship to the commission, security provisions for data and data-sharing rules;

(3) current impacts of federal legal and regulatory changes on health care costs, benefits, coverages and delivery systems that have been issued by the federal government that affect health care delivery or payment, including any changes that might affect graduate medical education funding;

(4) review and recommendations for efficiency improvements and cost savings, including bulk purchasing, of public sector programs and products where feasible and beneficial to increase the number of individuals covered, restrain cost growth and improve value and outcomes;

(5) assessment of potential and possible health care and prescription drug cost transparency tools for consumers, payers and providers;

(6) assessment of health care disparities and barriers to access in the state, both rural and urban, strategies for promoting recruitment and retention of providers, decentralized provider training programs, analysis of geographic and provider access barriers, needs and impact of the uninsured and the role of emerging solutions, including the use of technology to address access and quality needs;

(7) payment and service delivery components of the total health care sector in the state and a cost growth estimate;

(8) steps to fund and implement an all-payer claims database;

(9) impacts of federal legal and regulatory changes on health care costs, benefits, coverages and delivery systems;

(10) administrative reorganization or coordination, including bulk purchasing, of public sector programs and products where feasible and beneficial to increase the number of individuals covered, restrain cost growth and improve value and outcomes;

(11) development of health care and prescription drug cost transparency tools for consumers, payers and providers;

(12) strategies for developing and implementing health care quality and value improvement measures, including measures to curb medical and pharmaceutical waste;

(13) health care delivery system improvements and accountability, including promoting recruitment and retention of providers, development of medical homes, evaluation of community-based delivery systems, analysis of geographic access issues and review of utilization trends; and

(14) impact of technology on health care.

B. By November 1, 2021 and by November 1 each year thereafter, the commission shall meet to evaluate adherence and needed revisions to the commission's operational plan. The commission shall generate a progress report that shall be presented to the governor and legislature.

SECTION 9. [NEW MATERIAL] EXECUTIVE DIRECTOR--STAFF.--

A. The commission shall appoint an executive director of the commission. The executive director shall have at least five years' experience in health care policy, management, delivery, financing or coverage. The commission shall develop a process for evaluating the executive director's performance. The executive director shall carry out the day-to-day operations of the commission.

B. The executive director of the commission:

(1) shall employ and fix the compensation of those persons necessary to discharge the duties of the commission, including regular, full-time employees;

(2) shall propose to the commission an annual budget for the commission;

(3) shall report to the commission no less than once monthly from July 1, 2019 until July 1, 2020 and no less than quarterly after July 1, 2020;

(4) may contract with persons for professional services that require specialized knowledge or expertise; and

(5) may organize staff into operational units as the executive director sees fit in order to facilitate the commission's work.

SECTION 10. [NEW MATERIAL] HEALTH CARE VALUE AND ACCESS COMMISSION FUND--CREATION--APPROPRIATIONS.--

A. The "health care value and access commission fund" is created as a nonreverting fund in the state treasury. The fund shall consist of revenue from assessments and other sources pursuant to Paragraph (10) of Subsection C of Section 3 of the Health Care Value and Access Commission Act, appropriations, reimbursements, gifts, grants, donations and bequests made to the fund. Income from the fund shall be credited to the fund, and money in the fund shall not revert or be transferred to any other fund at the end of a fiscal year.

B. The commission shall administer the fund. Money in the fund is appropriated to the commission to carry out the provisions of the Health Care Value and Access Commission Act.

C. Money in the fund shall be disbursed on warrants signed by the secretary of finance and administration pursuant to vouchers signed by the chair or the chair's authorized representative.

SECTION 11. Section 24-14A-3 NMSA 1978 (being Laws 1989, Chapter 29, Section 3, as amended) is amended to read:

"24-14A-3. HEALTH INFORMATION SYSTEM--CREATION--DUTIES OF DEPARTMENT.--

A. The "health information system" is created for the purpose of assisting the department, legislature, health care value and access commission and other agencies and organizations in the state's efforts in collecting, analyzing and disseminating health information to assist:

(1) in the performance of health planning and policymaking functions, including identifying personnel, facility, education and other resource needs and allocating financial, personnel and other resources where appropriate;

(2) consumers in making informed decisions regarding health care; and

(3) in administering, monitoring and evaluating a statewide health plan.

B. In carrying out its powers and duties pursuant to the Health Information System Act, the department shall not duplicate databases that exist in the public sector or databases in the private sector to which it has electronic access. Every governmental entity shall provide the department with access to its health-related data as needed by the department. The department shall collect data from data sources in the most cost-effective and efficient manner.

C. The department shall establish, operate and maintain the health information system.

D. In establishing, operating and maintaining the health information system, the department shall:

(1) obtain information on the following health factors:

(a) mortality and natality, including accidental causes of death;

(b) morbidity;

(d) disability;

(e) health system costs, availability, utilization and revenues;

(f) environmental factors;

(g) health personnel;

(h) demographic factors;

(i) social, cultural and economic conditions affecting health, including language preference;

(j) family status;

(k) medical and practice outcomes as measured by nationally accepted standards and quality of care; and

(l) participation in clinical research trials;

(2) give the highest priority in data gathering to information needed to implement and monitor progress toward achievement of the state health policy, including determining where additional health resources such as personnel, programs and facilities are most needed, what those additional resources should be and how existing resources should be reallocated;

(3) standardize collection and specific methods of measurement across databases and use scientific sampling or complete enumeration for collecting and reporting health information;

(4) take adequate measures to provide health information system security for all health data acquired under the Health Information System Act and protect individual patient and health care practitioner confidentiality. The right to privacy for the individual shall be a major consideration in the collection and analysis of health data and shall be protected in the reporting of results;

(5) adopt and promulgate rules necessary to establish and administer the provisions of the Health Information System Act, including an appeals process for data sources and procedures to protect data source proprietary information from public disclosure;

(6) establish definitions, formats and other common information standards for core health data elements of the health information system in order to provide an integrated financial, statistical and clinical health information system, including a geographic information system, that allows data sharing and linking across databases maintained by data sources and federal, state and local public agencies;

(7) develop and maintain health and health-related data inventories and technical documentation on data holdings in the public and private sectors;

(8) collect, analyze and make available health data to support preventive health care practices and to facilitate the establishment of appropriate benchmark data to measure performance improvements over time;

(9) establish and maintain a systematic approach to the collection and storage of health data for longitudinal, demographic and policy impact studies;

(10) use expert system-based protocols to identify individual and population health risk profiles and to assist in the delivery of primary and preventive health care services;

(11) collect health data sufficient for consumers to be able to evaluate health care services, plans, providers and payers and to make informed decisions regarding quality, cost and outcome of care across the spectrum of health care services, providers and payers;

(12) collect comprehensive information on major capital expenditures for facilities, equipment by type and by data source and significant facility capacity reductions; provided that for the purposes of this paragraph and Section 24-14A-5 NMSA 1978, "major capital expenditure" means purchases of at least one million dollars ($1,000,000) for construction or renovation of facilities and at least five hundred thousand dollars ($500,000) for purchase or lease of equipment, and "significant facility capacity reductions" means those reductions in facility capacities as defined by the department;

(13) serve as a health information clearinghouse, including facilitating private and public collaborative, coordinated data collection and sharing and access to appropriate data and information, maintaining patient and client confidentiality in accordance with state and federal requirements;

(14) collect data in the most cost-efficient and effective method feasible and adopt rules that place a limit on the maximum amount of unreimbursed costs that a data source can incur in any year for the purposes of complying with the data requirements of the Health Information System Act; [and]

(15) identify disparities in health care access and quality by aggregating the information collected pursuant to Paragraph (1) of this subsection by population subgroups to include race, ethnicity, gender and age; and

(16) share data with the health care value and access commission, in a format and manner determined pursuant to a memorandum of agreement between the department and the commission.

E. The health care value and access commission is authorized to access all data submitted to the department and to determine the frequency and content of reports generated from data received from providers, health care provider associations and health coverage entities. The department shall not duplicate reports generated by the commission.

F. As used in this section, "health coverage entity" means an entity that is subject to the laws of this state and that contracts or offers to contract, or enters into agreements to provide, deliver, arrange for, pay for or reimburse any costs of health care services, or that provides, offers or administers health benefits plans or managed health care plans in this state. A "health coverage entity" includes a health insurance company, a health maintenance organization, a managed care organization, a third-party administrator, a hospital and health services corporation, a provider service network or a nonprofit health care plan."

SECTION 12. APPROPRIATION.--Two million dollars ($2,000,000) is appropriated from the general fund to the health care value and access commission fund for expenditure in fiscal year 2020 and subsequent fiscal years to fund the establishment of the health care value and access commission established pursuant to the Health Care Value and Access Commission Act and execution of the provisions of that act. Any unexpended or unencumbered balance remaining at the end of a fiscal year shall not revert to the general fund.

SECTION 13. REPEAL.--Section 9-7-11.2 NMSA 1978 (being Laws 1991, Chapter 139, Section 2, as amended) is repealed.

SECTION 14. SEVERABILITY.--If any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.

SECTION 15. EMERGENCY.--It is necessary for the public peace, health and safety that this act take effect immediately.

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