44th legislature - STATE OF NEW MEXICO - second session, 2000

RELATING TO HEALTH; ENACTING THE HEALTH CARE ACCESS ACT; CREATING THE ESSENTIAL COMMUNITY PROVIDER FUND; PROVIDING FOR TRANSFERS AND DISTRIBUTIONS TO THE FUND; PROVIDING FOR DISBURSEMENTS FROM THE FUND; AMENDING CERTAIN SECTIONS OF THE NMSA 1978; MAKING AN APPROPRIATION.

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

Section 1. [NEW MATERIAL] SHORT TITLE.--Sections 1 through 5 of this act may be cited as the "Health Care Access Act".

Section 2. [NEW MATERIAL] FINDINGS.--The legislature finds that as a matter of public policy it is necessary to provide health care access to the underserved population in New Mexico. The legislature further finds that it is necessary to provide flexible and shared solutions to address the problems of the underserved.

Section 3. [NEW MATERIAL] DEFINITIONS.--As used in the Health Care Access Act:

A. "contributing entity" means a county when making transfers to the fund pursuant to the Indigent Hospital and County Health Care Act; the department when making transfers to the fund pursuant to the Rural Primary Health Care Act; or a state institution;

B. "department" means the department of health;

C. "essential community provider" means a provider that participates in the medicaid and medicare programs and includes:

(1) a sole community hospital, a critical access hospital, an essential access community hospital, a sole provider hospital designated by the federal health care finance authority and a hospital qualified to receive a disproportionate share of medicaid or medicare payments;

(2) a federally qualified health center, a federally designated rural health clinic, a nonprofit primary care health clinic and a primary health care provider that is the only provider in the community;

(3) a department facility; and

(4) the following providers if certified by the department as an essential community provider based upon a proven record of providing essential community health care services:

(a) a school health program that is linked to an essential community provider;

(b) a home health agency; and

(c) a behavioral health service agency;

D. "essential community provider network" means at least two or more essential community providers described in Paragraphs (1) through (3) of Subsection C of this section that, pursuant to a written agreement, join together for the purpose of obtaining funds and providing services pursuant to the provisions of the Health Care Access Act; and

E. "fund" means the essential community provider fund.

Section 4. [NEW MATERIAL] FUND CREATED--TRANSFERS--MATCH.--

A. The "essential community provider fund" is created in the state treasury. The fund shall consist of money transferred to the fund by contributing entities, money appropriated to the fund and money transferred to the fund by the human services department pursuant to law. Earnings of the fund shall be credited to the fund, and unexpended or unencumbered balances in the fund shall not revert. Disbursements from the fund shall be made only by warrants issued by the department of finance and administration upon vouchers signed by the secretary of health. Money in the fund is appropriated to the department for the purposes of complying with the provisions of the Health Care Access Act.

B. Each fiscal year, by a deadline established by rule of the department, a contributing entity may transfer money to the fund for the purposes of obtaining services for underserved populations pursuant to the Health Care Access Act. The department or the human services department shall match money transferred to the fund by a contributing entity with any eligible and available federal funds or grants. If, within the time frame set by rule of the department, which shall be at least thirty days, the department, or the human services department is unable to match the money transferred by the contributing entity, the amount transferred shall be refunded to the contributing entity. If, within that time frame, the department or the human services department is able to match the money transferred by the contributing entity, distributions shall be made from the fund pursuant to Section 5 of the Health Care Access Act.

Section 5. [NEW MATERIAL] PAYMENTS TO ESSENTIAL COMMUNITY PROVIDERS.--

A. The department shall enter into agreements with essential community providers, essential community provider networks or participating local governments having contracts with essential community providers to make payments from the fund for health care services provided to the underserved. In entering into the agreements, the parties shall incorporate provisions that maintain an existing infrastructure of the safety net for essential community health services, reduce and avoid duplication of services, promote preventive care and personal responsibility, improve health status, access and continuity of care, establish standards for eligibility and reimbursement and promote quality and efficiency in a health care delivery system. Distributions from the fund shall be made pursuant to the agreements; provided that:

(1) a contributing entity other than the department shall receive payments from the fund in an amount that is no less than two hundred percent of its contribution to the fund and if that level of matching cannot be obtained, then the contribution shall be refunded;

(2) the department shall develop a formula based on the indigency level of a county population as a percentage of the indigency level of the state population, which will be extrapolated from income level, and distribute money being allocated under the Health Care Access Act based on that percentage. If a county contributes less than its maximum allowable contribution percentage, the department shall proportionately increase the maximum allowable contribution percentage for the other counties; and

(3) no distributions shall be made from the fund to supplant any general fund support for the medicaid program.

B. The department shall promulgate rules that are necessary to carry out the provisions of the Health Care Access Act.

Section 6. Section 24-1A-1 NMSA 1978 (being Laws 1981, Chapter 295, Section 1) is amended to read:

"24-1A-1. SHORT TITLE.--[This act] Chapter 24, Article 1A NMSA 1978 may be cited as the "Rural Primary Health Care Act"."

Section 7. Section 24-1A-3.1 NMSA 1978 (being Laws 1983, Chapter 236, Section 3, as amended) is amended to read:

"24-1A-3.1. DEPARTMENT--TECHNICAL AND FINANCIAL ASSISTANCE.--To the extent funds are made available for the purposes of the Rural Primary Health Care Act, the department is authorized to:

A. provide for a program to recruit and retain health care personnel in health care underserved areas;

B. develop plans for and coordinate the efforts of other public and private entities assisting in the provision of primary health care services through eligible programs;

C. provide for technical assistance to eligible programs in the areas of administrative and financial management, clinical services, outreach and planning;

D. provide for distribution of financial assistance to eligible programs that have applied for and demonstrated a need for assistance in order to sustain a minimum level of delivery of primary health care services; [and]

E. provide a program for enabling the development of new primary care health care services or facilities, and that program:

(1) shall give preference to communities that have few or no community-based primary care services;

(2) may require in-kind support from local communities where primary care health care services or facilities are established;

(3) may require primary care health care services or facilities to [assure] ensure provision of health care to the medically indigent; and

(4) shall permit the implementation of innovative and creative uses of local or statewide health care resources, or both, other than those listed in Paragraphs (2) and (3) of this subsection; and

F. transfer appropriations made to implement the provisions of and to fulfill the purposes of the Rural Primary Health Care Act to the essential community provider fund pursuant to the Health Care Access Act for the purpose of matching available federal funds, but payments made from the amount resulting shall be made in strict compliance with the provisions of the Rural Primary Health Care Act. Payments from the fund pursuant to the provisions of the Rural Primary Health Care Act shall be in at least the same proportion as the transfers made by the department to the fund, but in no case shall the expenditures from the fund for the purposes of the Rural Primary Health Care Act be less than the transfer the department makes to the fund, plus any matching funds received as a result of the transfer."

Section 8. Section 27-5-6 NMSA 1978 (being Laws 1965, Chapter 234, Section 6, as amended) is amended to read:

"27-5-6. POWERS AND DUTIES OF THE BOARD.--The board:

A. shall administer claims pursuant to the provisions of the Indigent Hospital and County Health Care Act;

B. shall prepare and submit a budget to the board of county commissioners for the amount needed to defray claims made upon the fund and to pay costs of administration of the Indigent Hospital and County Health Care Act and costs of development of a countywide or multicounty health plan. The combined costs of administration and planning shall in no event exceed the following percentages of revenues based on the previous fiscal year revenues for a fund that has existed for at least one fiscal year or based on projected revenues for the year being budgeted for a fund that has existed for less than one fiscal year. The percentage of the revenues in the fund that may be used for such combined administrative and planning costs is equal to the sum of the following:

(1) ten percent of the amount of the revenues in the fund not over five hundred thousand dollars ($500,000);

(2) eight percent of the amount of the revenues in the fund over five hundred thousand dollars ($500,000) but not over one million dollars ($1,000,000); and

(3) four and one-half percent of the amount of the revenues in the fund over one million dollars ($1,000,000);

C. shall make rules [and regulations] necessary to carry out the provisions of the Indigent Hospital and County Health Care Act; provided that the standards for eligibility and allowable costs for county indigent patients shall be no more restrictive than the standards for eligibility and allowable costs prior to December 31, 1992;

D. shall set criteria and cost limitations for medical care in licensed out-of-state hospitals, ambulance services or health care providers;

E. shall cooperate with appropriate state agencies to use available funds efficiently and to make health care more available;

F. shall cooperate with the department in making [any] an investigation to determine the validity of claims made upon the fund for any indigent patient;

G. may accept contributions or other county revenues, which shall be deposited in the fund;

H. may hire personnel to carry out the provisions of the Indigent Hospital and County Health Care Act;

I. shall review all claims presented by a hospital, ambulance service or health care provider to determine compliance with the rules [and regulations] adopted by the board or with the provisions of the Indigent Hospital and County Health Care Act, determine whether the patient for whom the claim is made is an indigent patient and determine the allowable medical, ambulance service or health care services costs; provided that the burden of proof of any claim shall be upon the hospital, ambulance service or health care provider;

J. shall state in writing the reason for rejecting or disapproving any claim and shall notify the submitting hospital, ambulance service or health care provider of the decision within sixty days after eligibility for claim payment has been determined;

K. shall pay all claims that are not matched with federal funds under the state medicaid program and that have been approved by the board from the fund and shall make payment within thirty days after approval of a claim by the board;

L. shall determine by county ordinance the types of health care providers that will be eligible to submit claims under the Indigent Hospital and County Health Care Act;

M. shall review, verify and approve all medicaid sole community provider hospital payment requests in accordance with rules [and regulations] adopted by the board prior to their submittal by the hospital to the department for payment but no later than January 1 of each year;

N. shall transfer to the state treasurer by the last day of March, June, September and December of each year an amount equal to one-fourth of the county's payment for support of sole community provider payments as calculated by the department for that county for the current fiscal year. This money shall be deposited in the sole community provider fund;

O. may provide for the transfer of money from the county indigent hospital claims fund to the county-supported medicaid fund to meet the requirements of the Statewide Health Care Act; [and]

P. may contract with ambulance providers, hospitals or health care providers for the provision of health care services; and

Q. may make transfers to the essential community provider fund for the purposes of obtaining benefits pursuant to the Health Care Access Act; provided that transfers made pursuant to this subsection are in addition to, and not in lieu of, the transfers made and required pursuant to Subsections N and O of this section."