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F I S C A L I M P A C T R E P O R T

SPONSOR Sanchez, B.

DATE TYPED 2/28/05

HB

SHORT TITLE Health Education Cultural Competence

SB 785/aSPAC

ANALYST Woods

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Regulation and Licensing Department (RLD)

Health Policy Commission (HPC)

Commission on the Status of Women (CSW)

Department of Health (DOH)

Department of Indian Affairs (DIA)

New Mexico Medical Board (NMMB)

New Mexico Board of Nursing (NMBN)

SUMMARY

Synopsis of SPAC Amendment

Senate Public Affairs Committee Amendment to SB785 clarifies language as follows:

•

On page 2, line 14: strike the word “and” and insert a comma in lieu thereof.

•

On page 2, line 15: after the word “American” insert the text “and African-

American”.

This amendment to SB785 adds no appropriation to the bill.

Synopsis of Original Bill

Senate Bill 785 – For the Legislative Health and Human Services Committee: An Act Relating to

Health; Establishing Cultural Competence Education Requirements in Certain Health Education Pro-

grams – seeks the following the following:

Senate Bill 785/aSPAC -- Page 2

Section 1. With respect to the requirement of Cultural Competence Health Education:

A. New Mexico institutions of higher education offering health education programs, both those

culminating in a specific health-related degree and those resulting in completion of a curriculum

in health-related technical competence, shall include courses ensuring knowledge of cultural

awareness and competence in their respective health service fields; further,

•

the curricula shall be required in four-year institutions; branch, community and junior col-

leges; and vocational and trade schools offering higher education degrees; and

•

the curricula shall be required at the undergraduate and at the graduate level; provided

that health students who have successfully completed cultural competence course work at

the undergraduate level may be exempt from duplicate requirements at the graduate study

level.

B. the Commission on Higher Education shall lead a task force on cultural competence com-

posed of the following:

•

health curricula specialists from each New Mexico institution of higher education;

•

a single representative from each New Mexico health-related licensing board;

•

a single representative from each statewide health-related professional association;

•

one representative from the New Mexico Health Policy Commission;

•

one representative from the Commission on the Status of Women;

•

one representative each from statewide Hispanic and Native American organizations;

•

two representatives from the Indian Affairs Department; and

•

two representatives from the Department of Health.

C. The task force shall study and make recommendations on specific course curricula for each

health-related education field offered. The course work shall be designed to be offered electroni-

cally and through various distance-education methods and media so as to minimize duplication

and expense. Cultural competence health courses shall include:

•

cross-cultural communication;

•

culturally and linguistically appropriate health policy considerations;

•

exploration of health beliefs and explanatory models;

•

culturally competent health care delivery;

•

health disparities, privilege and equity factors in the health system; and

•

culturally and linguistically competent care supported by policy, administration and practice.

Section 2. With respect to the Uniform Licensing Act, new language as applied to Health Profes-

sional Boards:

“The boards of health-related licensed professions regulated under Chapter 61, Articles 2, 3,

4, 5A, 6, 7A, 8, 9, 9A, 10, 11, 12A, 12B, 12C, 12D, 12E, 13, 14A, 14B, 14D, 14E and 17A

NMSA 1978 shall study and recommend to the governor and the legislative finance commit-

tee by August 2006 the continuing education courses to be required for licensure and license

renewal by members of their respective professions. In preparing their recommendations, the

boards shall consider the course curricula recommended for adoption at New Mexico institu-

Senate Bill 785/aSPAC -- Page 3

tions of higher education by the commission on higher education's task force on cultural

competence."

Significant Issues

The Department of Health (DOH) indicates that New Mexico is a majority-minority state, with a

culturally diverse population; combined, people of cultural, linguistic, and racial minority com-

prise more than 50 percent of the state’s population. Native American Indians are diverse and

include two Apache tribes, three bands in the Navajo Nation, and 19 Pueblos throughout the

State of New Mexico. Native American Indians are indigenous to the state and region. Hispan-

ics have lived in the southwest region for more than 400 years. Both groups have been major

contributors to the cultural and linguistic wealth of the state. In addition, people of African de-

scent have been living in New Mexico and contributing to the state’s cultural and economic

wealth since the sixteenth century. Further, that it is important that health professionals serving

the culturally diverse populations in New Mexico demonstrate an ability to function across cul-

tural differences appropriately and effectively with respect to the diverse cultural mores and un-

derstandings of the people.

The Commission on the Status of Women suggests that cultural competence would ensure the

highest quality of medical care to New Mexicans because the medical professionals providing

that care would be sensitive to the cultural differences between groups such as Native Ameri-

cans, Hispanics, African Americans and women; while the Department of Indian Affairs ob-

serves that the legislation would address the need for health care providers and organizations to

understand and respond effectively to the cultural and linguistic needs brought by patients to the

health care setting.

The New Mexico Medical Board (NMMB) agrees that cultural competence is a key skill for

health care professionals to develop, and leads to better communication between physician and

patient, which in turn leads to more accurate diagnoses, improved patient participation in and

understanding of treatment plans, and improved medication and treatment compliance. Further,

that the addition of cultural competence courses to health-related education programs is an ap-

propriate step in helping health care professionals gain this valuable skill. However, the NMMB

cautions that these requirements could have an adverse impact on physicians who are not initially

trained within the state and are considering a practice in New Mexico.

The New Mexico Board of Nursing (NMBN) adopts a similar posture with respect to the pro-

posed legislation indicating that the curriculum of nursing programs in New Mexico already ad-

dresses the issues of cultural awareness and competence. These issues are incorporated through-

out each specific nursing course and are therefore continually addressed throughout the academic

career of the nursing student. All nursing program curriculums in New Mexico currently include

content dealing with cultural awareness and competence as students are expected to care for cli-

ents/patients from other cultures. The national nursing examination (NCLEX) for entry in to

practice also includes questions regarding culture awareness and competence. The Board feels

confident that cultural competency is addressed adequately for initial licensure.

PERFORMANCE IMPLICATIONS

DOH indicates that the legislation supports the department’s strategic plan, Program Area 1:

Prevention and Disease Control, Strategic Direction: Improve the Health of New Mexicans; and

Senate Bill 785/aSPAC -- Page 4

Program Area 2, Health Care Delivery, Strategic Direction: Improve access to health services.

The Regulation and Licensing Department (RLD) indicates that the legislation will require every

health-related professional board through the task force to incorporate a curricula that provides

courses on cultural competence health education for initial licensure and for continuing educa-

tion, which will require multiple meetings for the task force outlined above, and which will fur-

ther be impacted by the rulemaking implementation process. Moreover, that this will place an

undue burden on the boards when the administrative and financial resources for administering

the Act are unavailable and not provided for in the legislation. Additionally, RLD implies that

most of the health-related professional boards have national standards for the curricula outlined

in statute and, therefore, the legislation may result in a conflict to each board’s statutory re-

quirements.

NMMB notes that it does not currently have any continuing education requirements for initial

licensure, and feels that establishing such would create an additional and unreasonable hurdle for

licensure. Only about half of the licensed physicians currently licensed in New Mexico actually

practice in the state, and a requirement for continuing education related to “cultural competence”

may not be relevant or possible to attain out of state. The board observes:

“We need to make sure we are not suspending the license of physicians because they

did not require education that is not readily available. At a time when we are trying

to encourage more physicians to practice in New Mexico, another requirement, no

matter how valuable, may serve to discourage, rather than encourage.”

FISCAL IMPLICATIONS

There is no appropriation attached to this legislation.

OTHER SUBSTANTIVE ISSUES

As general background to this initiative, the Health Policy Commission offers the following ob-

servations:

1

•

Findings from a survey of 24 post-secondary schools in New Mexico offering training for

health professions indicate that:

(a) 79 percent of the schools surveyed said their curricula always or fre-

quently included coursework in cultural and linguistic competence.

(b) Most of the respondents indicated that their programs in health care did

not include individual courses focused on intercultural communication

competence.

(c) A majority of respondents also indicated that demonstration of cultural

and linguistic competency was not a requirement for graduation from their

1

SOURCE: Report of Senate Joint Memorial 13 “The Study of Cultural and Linguistic Issues in Health Care in New

Mexico.” New Mexico Department of Health, October 1, 2004)

Senate Bill 785/aSPAC -- Page 5

programs in health care.

•

Of the health professional licensing boards in New Mexico, only the board regulating the

licensure of social workers was identified as having cultural competency requirements, as

it requires social workers to pass the New Mexico Cultural Awareness Examination to le-

gally practice in the state.

BFW/lg:yr