HOUSE BILL 34

50th legislature - STATE OF NEW MEXICO - first session, 2011

INTRODUCED BY

Danice Picraux and Dede Feldman

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

AN ACT

RELATING TO HEALTH INSURANCE; AMENDING THE PUBLIC ASSISTANCE ACT TO PROVIDE THAT MEDICAID, STATE CHILDREN'S HEALTH INSURANCE PROGRAM AND STATE COVERAGE INITIATIVE PROGRAM CONTRACTS WITH MANAGED-CARE ORGANIZATIONS INCLUDE SPECIFICATIONS FOR FUNDING MEDICAL HOMES.

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

     SECTION 1. Section 27-2-12.15 NMSA 1978 (being Laws 2009, Chapter 143, Section 1) is amended to read:

     "27-2-12.15. MEDICAID, STATE CHILDREN'S HEALTH INSURANCE PROGRAM AND STATE COVERAGE INITIATIVE PROGRAM MEDICAL HOME WAIVER--RULEMAKING--APPLICATION FOR WAIVER OR STATE PLAN AMENDMENT.--

          A. Subject to the availability of state funds and consistent with the federal Social Security Act, the department shall work with its contractors that administer the state's approved waiver programs to promote and [if practicable] develop a program called the "medical home program". The "medical home" is an integrated care management model that emphasizes primary medical care that is continuous, comprehensive, coordinated, accessible, compassionate and culturally appropriate. Care within the medical home includes primary care, preventive care and care management services and uses quality improvement techniques and information technology for clinical decision support. Components of the medical home model may include:

                (1) assignment of recipients to a primary care provider, clinic or practice that will serve as a medical home;

                (2) promotion of the health commons model of service delivery, whereby the medical home tracks recipients' primary care, specialty, behavioral health, dental health, home care and social services needs as much as practicable;

                (3) health education, health promotion, peer support and other services that may integrate with health care services to promote overall health;

                (4) health risk or functional needs assessments for recipients;

                (5) a method for reporting on the effectiveness of the medical home model and its effect upon recipients' utilization of health care services and the associated cost of utilization of those services;

                (6) mechanisms to reduce inappropriate emergency department utilization by recipients;

                (7) financial incentives for the provision of after-hours primary care;

                (8) mechanisms that ensure a robust system of care coordination for assessing, planning, coordinating and monitoring recipients with complex, chronic or high-cost health care or social support needs, including attendant care and other services needed to remain in the community;

                (9) implementation of a comprehensive, community-based initiative to educate recipients about effective use of the health care delivery system, including the use of community health workers or promotoras;

                (10) strategies to prevent or delay institutionalization of recipients through the effective utilization of home- and community-based support services;

                (11) a primary care provider for each recipient, who advocates for and provides ongoing support, oversight and guidance to implement an integrated, coherent, cross-disciplinary plan for ongoing health care developed in partnership with the recipient and including all other health care providers furnishing care to the recipient;

                (12) implementation of evidence-based medicine and clinical decision support tools to guide decision-making at the point-of-care based upon recipient-specific factors;

                (13) use of comparative effectiveness to make a cost-benefit analysis of health care practices;

                (14) use of health information technology, including remote supervision, recipient monitoring and recipient registries, to monitor and track the health status of recipients;

                (15) development and use of safe and secure health information technology to promote convenient recipient access to personal health information, health services and web sites with tools for patient self-management;

                (16) implementation of training programs for personnel involved in the coordination of care for recipients;

                (17) implementation of equitable financial incentive and compensation systems for primary care providers and other staff engaged in care management and the medical home model; and

                (18) any other components that the secretary determines will improve a recipient's health outcome and that are cost-effective.

          B. Beginning with fiscal year 2012, the department shall specify in its contracts with each contractor that the contractor allocate funds to establish and maintain a medical home program.

          [B.] C. For the purposes of this section:

                (1) "contractor" means a person that contracts with the department to administer the state's coverage programs for medicaid, the state children's health insurance program or the state coverage initiative program; and

                (2) "primary care provider" means a medical doctor or physician assistant licensed under the Medical Practice Act to practice medicine in New Mexico, an osteopathic physician licensed pursuant to Chapter 61, Article 10 NMSA 1978, an osteopathic physician's assistant licensed pursuant to the Osteopathic Physicians' Assistant Act, a pharmacist clinician licensed or certified to prescribe and administer drugs that are subject to the New Mexico Drug, Device and Cosmetic Act or a certified nurse practitioner as defined in the Nursing Practice Act who provides first contact and continuous care and who has the staff and resources to manage the comprehensive and coordinated health care of each individual under the primary care provider's care."

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