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F I S C A L I M P A C T R E P O R T
SPONSOR Papen
DATE TYPED 1/31/05
HB
SHORT TITLE Rural Primary Health Care Clinics
SB 110
ANALYST Collard
APPROPRIATION
Appropriation Contained Estimated Additional Impact Recurring
or Non-Rec
Fund
Affected
FY05
FY06
FY05
FY06
$2,000.0
Recurring General Fund
(Parenthesis ( ) Indicate Expenditure Decreases)
Duplicates HB 264
Relates to SB 8 and SB 11
Relates to Appropriation in the General Appropriation Act
SOURCES OF INFORMATION
LFC Files
Responses Received From
Department of Health (DOH)
Health Policy Commission (HPC)
New Mexico Finance Authority (NMFA)
SUMMARY
Synopsis of Bill
Senate Bill 110 appropriates $2 million from the general fund to the Department of Health for
the purpose of increasing the capacity of rural primary health care clinics under the Rural Pri-
mary Health Care Act to increase access to uninsured patients in New Mexico and maintain the
primary care safety net.
Significant Issues
DOH notes despite significant progress over the years there are still gaps in access to dental and
primary care services for many New Mexicans who reside in underserved areas of the state. The
Federal government has designated all or part of 28 New Mexico counties as either medical or
dental Health Professional Shortage Areas. Dental services are inadequate due to a shortage of
licensed dentists, especially in rural and remote areas of the state.
pg_0002
Senate Bill 110 -- Page 2
PERFORMANCE IMPLICATIONS
HPC notes this bill does not establish baseline measurement criteria to determine how primary
care clinics will increase access. It is unclear whether more staff would be hired, or more clients
will be treated, or more equipment will be purchased, or the services hours would be extended,
etc. Additionally, the bill does not define what “cost-effective” health care services could entail.
FISCAL IMPLICATIONS
The appropriation of $2 million contained in this bill is a recurring expense to the general fund.
Any unexpended or unencumbered balance remaining at the end of FY06 shall revert to the gen-
eral fund.
ADMINISTRATIVE IMPLICATIONS
DOH indicates this bill would have some administrative impact upon the department. The addi-
tional appropriation would add additional procurement, contracting and monitoring activities to
existing workloads under the Rural Primary Health Care Act (RPHCA) Program. DOH could
administer this additional appropriation with current staff.
The New Mexico Finance Authority notes this bill would not have a fiscal or administrative im-
pact on the Primary Care Capital Fund administered by the NM Finance Authority.
DUPLICATION and RELATIONSHIP
Senate Bill 110 is related to Senate Bill 8, which would appropriate $1.2 million for similar pur-
poses and Senate Bill 11, which would provide financial support for pharmacy services at clinics
supported by RPHCA.
Senate Bill 110 duplicates House Bill 264.
OTHER SUBSTANTIVE ISSUES
DOH indicates the needs of underserved New Mexicans are met, in part, by a network of com-
munity-based primary care centers. This network provides basic services to more than 230 thou-
sand patients each year. The Rural Primary Health Care Act (RPHCA) Program, administered
by DOH, provides financial support to more than 80 clinics in the network. The majority of pa-
tients at community-based primary care centers are either indigent or Medicaid program partici-
pants. Indigent patients receive services according to sliding fee schedules, based upon their
ability to pay. It is estimated that an additional 200 thousand New Mexicans statewide could
benefit from the services of new or expanded health centers.
The President has established a Community Health Center Initiative for the nation aiming to
double the number of new or expanded community-based primary care centers nationwide by
2006. All new centers receiving this funding are required to provide both medical and dental
services to their patients. Primary care centers in New Mexico have competed successfully for
this funding over the last few years. New or expanded centers in Silver City, Edgewood, Mora,
Santa Fe, East Mesa (Dona Ana County), Fort Sumner, Socorro and Alamogordo have all bene-
fited from this Initiative. In the current fiscal year, federal applications are pending, or to be
submitted, for new or expanded centers in Bernalillo and Hobbs. In addition, there have been
numerous supplemental grants given to existing health centers to expand the comprehensiveness
pg_0003
Senate Bill 110 -- Page 3
of their services to include dental and basic behavioral health care. During the next year it is an-
ticipated that at least 5 applications could be developed for new or expanded health centers in
New Mexico. This would permit a significant expansion of our health care safety net. The ap-
propriation proposed in this bill could be used to supplement these federal grants and substan-
tially improve access to primary medical, dental and basic behavioral health care.
HPC notes the bill supports RPHCA’s priority of sustaining critical infrastructure of the ap-
proximately 70 medical and dental sites in 31 New Mexico counties.
According to the NM Primary Care Association, individual and community health primary care
clinics provide access to migrant workers, homeless persons and uninsured and underinsured
persons. Sixty-nine percent of all patients served by the association are below 200 percent of the
federal poverty level and 117 thousand are uninsured patients.
According to HPC, an estimated 23 percent of New Mexicans lack access to primary care, and
NM is ranked 4
th
in the nation for lacking access. (2003, Morgan Quitno Press citing US Dept. of
Health and Human Services, Div. Of Shortage Designation “Selected Statistics of Health Profes-
sional Shortage Areas”)
HPC also notes research published and cited in various literatures has estimated that 20 percent
of Americans live in rural areas, 18 percent of rural residents are elderly, 22 percent of Medicare
beneficiaries live in rural areas, rural square miles have low population densities, and medical
facilities are less likely to be found in a sparsely populated rural setting.
ALTERNATIVES
HPC proposes the alternative of implement telemedicine capability and capacity for consultation
and treatment, which will decrease the need to hire FTEs, purchase medical equipment, extend
clinic hours, etc.
KBC/lg