SENATE FLOOR SUBSTITUTE FOR

SENATE BILL 225

48th legislature - STATE OF NEW MEXICO - second session, 2008

AN ACT

RELATING TO HEALTH CARE REFORM; ENACTING THE HEALTH CARE AND POLICY COMMISSION ACT; CREATING THE HEALTH CARE AND POLICY COMMISSION; PROVIDING FOR POWERS AND DUTIES; REPEALING AND ENACTING SECTIONS OF THE NMSA 1978.

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

     Section 1. SHORT TITLE.--This act may be cited as the "Health Care and Policy Commission Act".

     Section 2. DEFINITIONS.--As used in the Health Care and Policy Commission Act:

          A. "board" means the board of directors of the commission;

          B. "commission" means the health care and policy commission;

          C. "health care services" means any services by a licensed provider included in the furnishing to any individual of medical, mental, dental, pharmaceutical or optometric care or hospitalization or nursing home care or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing or healing human physical or mental illness or injury;

          D. "health coverage" means any system to finance health care services;

          E. "health insurance" means any hospital or medical expense-incurred policy; nonprofit health care plan service contract or coverage of services; health maintenance organization subscriber contract or coverage of services; short-term, accident, fixed indemnity, specified disease policy or disability income insurance contracts and limited health benefit or credit health insurance; coverage for health care services under uninsured arrangements of group or group-type coverages, including employer self-insured, cost-plus or other benefits methodologies not involving insurance or not subject to New Mexico premium taxes; coverage for health care services under group-type contracts that are not available to the general public and can be obtained only because of connection with a particular organization or group; coverage by medicare or other governmental programs providing health care services; but "health insurance" does not include insurance issued pursuant to provisions of the Workers' Compensation Act or similar law, automobile medical payment insurance or provisions by which benefits are payable with or without regard to fault and are required by law to be contained in any liability insurance policy;

          F. "health insurer" means a person duly authorized in the state pursuant to the New Mexico Insurance Code to transact the business of health insurance; and

          G. "superintendent" means the superintendent of insurance or the superintendent's designee.

     Section 3. HEALTH CARE AND POLICY COMMISSION CREATED--MEMBERSHIP.--

          A. The "health care and policy commission" is created and is an adjunct agency within the meaning of the Executive Reorganization Act.

          B. The board shall consist of eleven members, at least one of whom shall be a Native American, one of whom shall be a physician licensed pursuant to the Medical Practice Act and one of whom shall be a nurse having a graduate-level education in nursing, selected as follows:

                (1) two members from each of the five public regulation commission districts:

                     (a) five of whom shall be appointed by the governor and subject to senate confirmation; and

                     (b) five of whom shall be appointed by the New Mexico legislative council with at least two appointments being made by council members from the minority party; and

                (2) the superintendent.

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

          D. Board members shall comply with the provisions of the Governmental Conduct Act and the Financial Disclosure Act.

          E. Each appointed board member shall have at least three years' experience in at least one of the following areas; provided, however, that all areas are represented on the board:

                (1) executive-level experience in management or finance in a business not related to health care;

                (2) experience in the field of health or human services consumer advocacy;

                (3) executive-level experience in a business not related to health care that employs ten or fewer individuals;

                (4) executive-level experience in a business not related to health care that employs eleven or more individuals;

                (5) experience in health care management or finance;

                (6) experience related to health policy;

                (7) experience in health care economics;

                (8) experience in labor organization and advocacy; and

                (9) experience in public health.

          F. Appointed board members initially shall have terms chosen by lot as follows: three members shall serve two-year terms; three members shall serve three-year terms; and four members shall serve four-year terms. Thereafter, members shall serve four-year terms. An appointed member shall not serve more than two consecutive terms. An appointed member shall serve until the member's successor is appointed and qualified or for six months, whichever period of time is shorter.

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

          H. Every even-numbered year the board shall elect its chair and vice chair in open session from any of the members. A chair or vice chair shall serve no more than one one-year term.

          I. A vacancy shall be filled by appointment by the original appointing authority for the remainder of the unexpired term.

           J. A member may be removed from the board by a majority vote of the members. The board shall set standards for attendance and may remove a member for lack of attendance, neglect of duty or malfeasance in office. A member shall not be removed without proceedings consisting of at least one notice of hearing and an opportunity to be heard. Removal proceedings shall be before the board and in accordance with procedures adopted by the board, including appeals procedures to the attorney general.

          K. A board member may receive per diem and mileage in accordance with the Per Diem and Mileage Act, subject to appropriation by the legislature and as travel policy is set by the board's bylaws.

          L. The board shall meet at the call of the chair and not less than once monthly from July 1, 2008 until December 31, 2009. Thereafter, the board shall meet no less often than once per calendar quarter. There shall be at least one week's notice given to members prior to any meetings. There shall be sufficient notice provided to the public prior to meetings, as provided per state law.

           M. The board is subject to and shall comply with the provisions of the Administrative Procedures Act as well as other statutes and rules applicable to state agencies.

          N. Any decisions by the board shall require seven out of eleven members voting in favor.

          O. The board shall report to the appropriate interim legislative committees at least once per calendar year, no later than October 1 of each year. 

     Section 4. COMMISSION POWERS--DUTIES.--

          A. The board may:

                (1) identity procedures to carry out the duties identified in Subsections B and C of this section;

                (2) create ad hoc advisory councils; and

                (3) request assistance from other boards, commissions, departments, agencies and organizations necessary to provide appropriate expertise to accomplish the commission's duties.

           B. The board shall create the following expert advisory councils to provide the board with policy, program and analysis recommendations to maximize commission efficiency and effectiveness. At least once every calendar quarter, each council shall present its findings and recommendations to the board on issues described below or those requested by the board. The councils shall include, at a minimum:

                (1) a finance council to study existing and prospective public and private health care system financing and cost-containment initiatives for a sustainable universal health care system;

                (2) a federal impact council to:

                     (a) examine the impact of federal legal and administrative requirements on, and make recommendations for, reducing the number of New Mexicans without health coverage, improving access to affordable health care and removing barriers to reducing the number of uninsured New Mexicans; and 

                     (b) recommend steps to maximize federal assistance and address federal requirements;

                (3) a Native American health council consisting of members of Native American tribes, nations and pueblos to examine Native American health care access needs and make recommendations on measures to improve access to health care for Native Americans;

                (4) a health disparities council consisting of representatives from underserved populations who have expertise in the causes and elimination of health disparities to make recommendations, including but not limited to, recommendations on the following issues:

                     (a) disparities in the disease rates among and between racial and ethnic populations;

                     (b) language and cultural barriers to health care access; and

                     (c) enrollment strategies appropriate for diverse populations;

                (5) a delivery system council to:

                     (a) examine prevention and wellness incentives and chronic disease management;

                     (b) make recommendations on new health care coverage and delivery systems and evidence-based health care quality and outcome indicators; and

                     (c) make recommendations on recruiting and retaining providers within the desired specialties or occupations; and

                (6) a council of state-funded or state-created health care or health coverage agencies or other entities to examine cost containment and benefit issues and make policy recommendations related to those issues.

          C. By January 1, 2009, the commission shall develop a comprehensive plan for accessible and affordable health care for all people living in New Mexico. The commission shall develop proposals and recommendations to the legislature and the governor, including but not limited to proposals and recommendations on the following issues:

                (1) the financing of a health care system that incorporates strategies from the public and private sectors;

                (2) the evaluation of insurance reforms, including guaranteed issue, community rating, preexisting conditions provisions, health savings accounts, medical loss ratios, a health insurance exchange and portability measures;

                (3) the definition of standards for a set of essential health care services;

                (4) the administrative reorganization or consolidation of public sector programs and products, where feasible and beneficial, to increase the number of individuals covered and to contain costs;

                (5) the assessment of the impact of federal laws and regulations and any changes in the structure of health coverage or policies;

                (6) the evaluation of statutory and regulatory initiatives to provide cost-effective health care services, including the evaluation of:

                     (a) how to provide access to information that would enable providers, consumers and purchasers to evaluate cost data fairly, including contractual terms such as reimbursement rates and provider charges, without compromising individual patient information;

                     (b) how to implement a statewide uniform health care provider credentialing process;

                     (c) the costs and benefits of improving the transparency of provider services and health benefit plans; and

                     (d) the costs and benefits of bulk purchasing of health care services, durable medical equipment, health care supplies and pharmaceuticals;

                (7) the evaluation of the current health care delivery services, including the evaluation of:

                     (a) the proper role of a comprehensive statewide system in providing acute medical care, behavioral health care, chronic medical care and disease management, preventive care and wellness, public health and patient education; and

                     (b) a system to align provider and insurer incentives to use evidence-based care and to produce healthy outcomes;

                (8) the setting of affordability standards for individuals and families, particularly uninsured individuals, relating to purchasing insurance coverage for the defined essential health services;

                (9) the development of a program that partners public health coverage programs with private health coverage plans to provide health insurance coverage that meets affordability standards;

                (10) the design of measures to make health insurers and health benefit plans accountable to the public and to state government;

                (11) the assessment of strategies for reducing racial and ethnic health care disparities and identifying underserved populations;

                (12) the evaluation of incentives for providers to utilize information technology to deliver efficient, safe and quality health care and to encourage the development of individual electronic medical records that protect patient privacy;

                (13) the evaluation of the feasibility of implementing programs to deliver local community-based health care services;

                (14) the examination of measures, targeted at local and statewide levels as appropriate, to improve health care outcomes while containing costs;

                (15) the operation of a health care system that provides a primary care medical home to individuals and provides information about the range, cost and quality of services offered by providers and plans; and

                (16) an examination of health professional malpractice issues that impact health care.

          D. The board 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 board shall develop a process for evaluating the executive director's performance. The executive director shall carry on the day-to-day operations of the commission. The executive director shall be exempt from the provisions of the Personnel Act.

     Section 5. HEALTH CARE AND POLICY COMMISSION--STAFF.--

          A. 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 an annual budget for the commission;

                (3) shall report to the board no less than once monthly from July 1, 2008 until July 1, 2009 and no less than once quarterly after July 1, 2009;

                (4) may contract with persons for professional services that require specialized knowledge or expertise or that are for short-term projects; and

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

          B. The commission's staff is subject to the provisions of the Personnel Act.

     Section 6. REPORTING AND USE OF DATA.--

          A. Health insurers and providers shall report to the commission data about health coverage, services delivered, incident and infection rates and outcomes achieved in a format required or approved by the commission after consultation with other state entities authorized to collect related data.

          B. Data reported shall be in aggregate form. Data shall be reported electronically to the extent possible. The commission shall use and report data received only in aggregate form and shall not use or release any individual-identifying information or corporate proprietary information for any purpose except as provided by state or federal law or by court order.

          C. In developing data reporting requirements, the commission shall seek and consider input from health insurers, providers, employers, advisory councils created pursuant to Section 4 of the Health Care and Policy Commission Act and the public regarding the format, timing and method of transmission of data to prevent duplicative reporting and to make the reporting of data the least burdensome possible.

          D. The commission may use data collected by provider associations or other entities and shall not request data already collected by and available from other state agencies.

     Section 7. TERMINATION OF AGENCY LIFE--DELAYED REPEAL.--

The health care and policy commission is terminated July 1, 2013 pursuant to the Sunset Act. The commission shall continue to operate according to the provisions of the Health Care and Policy Commission Act until July 1, 2014. Effective July 1, 2014, the Health Care and Policy Commission Act is repealed.

     Section 8. TEMPORARY PROVISION--NEW MEXICO HEALTH POLICY COMMISSION--TRANSFER OF PERSONNEL, PROPERTY, CONTRACTS AND REFERENCES IN LAW.--On July 1, 2008:

          A. all personnel, appropriations, money, records, equipment, legislative requests, supplies and other property of the New Mexico health policy commission shall be transferred to the health care and policy commission;

          B. all contracts of the New Mexico health policy commission shall be binding and effective on the health care and policy commission;

          C. all references in law to the New Mexico health policy commission shall be deemed to be references to the health care and policy commission; and

          D. the executive director of the New Mexico health policy commission shall be appointed as interim executive director of the health care and policy commission until the board of directors of the health care and policy commission appoints an executive director. 

     Section 9. REPEAL.--Section 9-7-11.2 NMSA 1978 (being Laws 1991, Chapter 139, Section 2, as amended) is repealed effective July 1, 2008.

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