HOUSE BILL 777
49th legislature - STATE OF NEW MEXICO - first session, 2009
INTRODUCED BY
John A. Heaton
AN ACT
RELATING TO PUBLIC HEALTH; PROVIDING FOR HOSPITAL-ACQUIRED CONDITION REPORTING; ESTABLISHING REPORTING REQUIREMENTS; ESTABLISHING QUALITY IMPROVEMENT REQUIREMENTS; PROHIBITING PAYMENT FOR CERTAIN SERIOUS REPORTABLE EVENTS; AMENDING THE PUBLIC ASSISTANCE ACT.
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 "Hospital-Acquired Conditions Act".
Section 2. [NEW MATERIAL] DEFINITIONS.--As used in the Hospital-Acquired Conditions Act:
A. "advisory committee" means the hospital-acquired conditions advisory committee;
B. "department" means the department of health;
C. "hospital" means a facility that provides emergency or urgent care, inpatient medical care and nursing care for acute illness, injury, surgery or obstetrics and that is licensed as a hospital by the department;
D. "hospital-acquired condition" means a condition that has been identified by the centers for medicare and medicaid services of the federal department of health and human services as a hospital-acquired condition and includes serious reportable events or a condition identified by the advisory committee as a hospital-acquired condition;
E. "indicator" means a measure of a hospital-acquired condition or other condition, process or serious reportable event identified and defined by the advisory committee that is based on objective, scientific standards and that may be tracked and reported;
F. "national healthcare safety network" means the secure, internet-based surveillance system that is managed by the centers for disease control and prevention of the federal department of health and human services;
G. "serious reportable event" means a preventable injury caused by care management, rather than an underlying disease, and errors that occur from failure to follow a standard of care or institutional practices and policies; and
H. "surveillance system" means a secure, internet-based system designed for the collection of hospital-acquired condition incidence and prevention data.
Section 3. [NEW MATERIAL] HOSPITAL-ACQUIRED CONDITIONS--ADVISORY COMMITTEE--REQUIRED REPORTING.--
A. The department shall conduct a statewide program of surveillance of hospital-acquired conditions for the purpose of public reporting and quality improvement in which each hospital in the state shall participate.
B. The "hospital-acquired condition advisory committee" is created in the department to conduct surveillance of hospital-acquired conditions and to make recommendations to the department about what indicators to consider for being subject to surveillance and reporting. Members of the advisory committee shall include:
(1) a consumer of health care services;
(2) a representative of the New Mexico association for professionals in infection control and epidemiology;
(3) a representative of the New Mexico hospital association;
(4) a representative of the New Mexico medical review association;
(5) a local representative of the society for healthcare epidemiology of America; and
(6) the department's infectious disease epidemiology bureau.
C. The advisory committee shall establish or use industry-accepted guidelines, definitions, criteria, standards and coding for hospital identification, tracking and reporting of hospital-acquired conditions, provided that all conditions selected by the centers for medicare and medicaid services as hospital-acquired conditions are adopted. Additionally, the advisory committee shall consider the following indicators: (1) central line associated bloodstream infections;
(2) surgical site wound infections;
(3) ventilator assisted pneumonia;
(4) catheter associated urinary tract infections; and
(5) other hospital-acquired conditions that the advisory committee may determine in consultation with technical advisors who are regionally or nationally recognized experts in the prevention, identification and control of hospital-acquired conditions and the public reporting of performance data.
D. Hospitals shall be required to identify, track and report hospital-acquired conditions identified by the department.
Section 4. [NEW MATERIAL] REPORTING REQUIREMENTS--PROTECTION OF DATA.--
A. By July 1, 2011, the department shall establish a hospital-acquired condition and serious reportable event reporting system capable of receiving electronically transmitted reports from hospitals.
B. The department shall maintain the data collected from hospitals in a database for the purpose of supporting quality improvement and infection control activities in hospitals. The database shall be organized so that consumers, hospitals, health care professionals, purchasers and payers may compare individual hospitals, regional and statewide averages, and, where available, national data.
C. The secretary of health shall submit a report to the governor and the legislature on hospital-acquired conditions and serious reportable events, adjusted for the potential differences in risk factors for each reporting hospital.
D. The department shall develop and implement an audit process to ensure that self-reported hospital-acquired conditions and serious reportable event data are accurate.
Section 5. [NEW MATERIAL] QUALITY IMPROVEMENT--REQUIREMENTS.--
A. Following the occurrence of any of the events specified in Subsection C of Section 3 of the Hospital-Acquired Conditions Act, a hospital reporting such occurrences shall conduct a root cause analysis and shall implement a corrective action plan in accordance with department regulations for licensure of hospitals.
B. The department shall conduct continuous quality improvement activities pursuant to the statewide program of surveillance of hospital-acquired conditions and serious events specified in Section 3 of the Hospital-Acquired Conditions Act. Continuous quality improvement activities shall include methods to provide public accountability for hospitals reporting hospital-acquired conditions and serious reportable events.
Section 6. Section 27-2-9 NMSA 1978 (being Laws 1973, Chapter 376, Section 13) is amended to read:
"27-2-9. PAYMENT FOR HOSPITAL CARE.--
A. Consistent with the federal act, the medical assistance division of the department shall provide necessary hospital care for recipients of public assistance other than those eligible under the general assistance program authorized by Section [10 of the Public Assistance Act] 27-2-7 NMSA 1978. The rate of payment for in-patient hospital services shall be based either on the reasonable cost or the customary cost of such services, whichever is less. In determining reasonable cost under this section, the [board] medical assistance division shall adopt regulations establishing a formula consistent with the federal act. The [department] division shall apply that formula to determine the amount to which each hospital is entitled as reimbursement for providing in-patient hospital services.
B. To receive reimbursement for providing in-patient hospital services, a hospital shall file annually with the [department] medical assistance division such information as the [department] division may reasonably require to determine reasonable costs or the hospital's customary cost of in-patient hospital services.
C. No hospital shall receive reimbursement for a hospital-acquired condition or treatment for a hospital-acquired condition as defined in the Hospital-Acquired Conditions Act.
[C.] D. Any hospital [entitled to] eligible for reimbursement for in-patient hospital services shall be entitled to a hearing, pursuant to regulations of the [board] medical assistance division consistent with applicable state law, if the hospital disagrees with the [department's] division's determination or denial of [the] reimbursement [the hospital is to receive]."
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